Medicare Coverage for PET Scans to Diagnose Alzheimer’s
Alzheimer’s disease, the most common form of dementia, affects four and a half million Americans. Although no cure has been found for the disease, it has been determined that early diagnosis and treatment can dramatically slow its progression.
Previously, Alzheimer’s could only be definitively diagnosed through a post-mortem autopsy. Now, however, positron emission tomography (PET) scans, a non-invasive scanning procedure that measures certain body processes, are being used to provide early Alzheimer’s diagnoses. While the scans cost anywhere from $ 1,200 to $ 2,500 each, they are 90 percent reliable in diagnosing Alzheimer’s
Based on the beneficial effects of early Alzheimer’s diagnosis, the Centers for Medicare and Medicaid Services, the agency that runs the Medicare program, has decided to cover PET scans for Medicare patients with suspected Alzheimer’s disease. Medicare patients who have been diagnosed with dementia and who have experienced a six-month decline in cognitive abilities are eligible for PET scans. In addition, PET scans are available to Medicare patients with early dementia or unexpected memory loss who are enrolled in clinical trials with certain safeguards for patients, including informed individualized analysis and an evaluation of the test results and the patient’s health status.
Early diagnosis and treatment of Alzheimer’s is important not only for the patient’s prognosis but also for the Medicare program. It is estimated that the number of Americans with Alzheimer’s disease will reach 16 million by the year 2050. According to the Alzheimer’s Association and the Alzheimer’s Research Forum, the estimated annual cost of Alzheimer’s patient care ranges from $18,408 for those in the mild stages of the disease to $36,132 in severe stages.
A majority of private health plans do not cover the cost of PET scans that are given in connection with Alzheimer’s disease. However, many health insurers and plans seek to provide at least the same level of coverage as that provided by Medicare. Therefore, it is possible that more and more private health plans will decide to cover PET scans that are used to diagnose Alzheimer’s disease. The potential long-run cost savings arising from an early diagnosis may convince private insurers to provide the coverage.
Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.
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