Medicare Could Cover Early Alzheimer's Blood Testing

Takeaways

• Alzheimer’s-related brain changes may begin years before symptoms appear. Researchers are developing blood tests to look for associated biological markers.
• Current blood tests have specific uses and limitations. They are not stand-alone tests for diagnosing Alzheimer’s disease or general checkups for people without symptoms.
• Many people do not receive an Alzheimer’s diagnosis during mild cognitive impairment, when symptoms first emerge and some treatments may be available.
• Medicare generally cannot cover routine blood-based Alzheimer’s screening tests under current law.
• If enacted, the bipartisan Alzheimer’s Screening and Prevention Act, or ASAP Act, could make it easier for Medicare to cover blood-based screening tests.
• Earlier evaluation may give people more time to discuss treatment, care, legal, and financial decisions, but testing can still involve significant out-of-pocket costs.

Alzheimer’s-related changes in the brain may begin years before symptoms appear. These changes are associated with biological markers that can be measured in blood, and researchers are developing blood tests that look for them. But current tests have specific uses and limits: A screening test identifies people who may need further evaluation. It does not, by itself, establish an Alzheimer’s or dementia diagnosis.

Blood testing is less invasive than brain imaging and may help doctors evaluate cognitive decline earlier. That matters because fewer than 10 percent of people receive an Alzheimer’s diagnosis when they have mild cognitive impairment — the stage when symptoms first emerge and people may be eligible for treatment.

The Alzheimer’s Association estimates that 7.4 million Americans age 65 and older are living with Alzheimer’s dementia in 2026.

Public interest in early answers is high. In one national survey, nearly four in five Americans say they would want to know if they had Alzheimer’s before symptoms progressed, and more than nine in 10 would want access to a simple medical test.

Who Should Consider Alzheimer’s Blood Testing?

At this time, available blood testing is generally used to help evaluate certain people who already have signs or symptoms of cognitive decline. It is not a general checkup for people who have no symptoms. A health care professional can help determine whether testing is appropriate based on a person’s symptoms, medical history, age, and other evaluation results.

Medicare Coverage and the ASAP Act

Medicare generally does not cover routine blood-based Alzheimer’s screening tests under current law. The obstacle is not necessarily the availability of the technology — under current law, Medicare cannot cover routine FDA-cleared Alzheimer’s screening tests unless Congress specifically gives it permission to do so.

That could change with the Alzheimer’s Screening and Prevention (ASAP) Act. If enacted, the bipartisan act would allow Medicare to consider and cover routine blood-based dementia screening tests cleared or approved by the FDA.

Without a clear coverage pathway, Medicare coverage of new dementia screening tools could take years, even after FDA authorization. The ASAP Act seeks to help Medicare keep pace with advances in detection while preserving the existing process used to evaluate which tests Medicare will cover.

How Blood Tests May Detect Alzheimer’s Disease Earlier

Lumipulse is an example of an FDA-cleared blood test used to aid the evaluation of Alzheimer’s disease in certain adults with signs or symptoms of cognitive decline. The test measures blood-based markers associated with amyloid plaques, a hallmark of Alzheimer’s disease.  It is not intended to be used by itself to screen people who have no symptoms or to establish a diagnosis. Physicians must interpret the results alongside a patient’s symptoms, medical history, and other evaluations.

What Happens After the Test?

A blood test is only one part of an Alzheimer’s evaluation. Depending on the result and the person’s symptoms, a doctor may recommend cognitive testing, a review of medical history, brain imaging, or another type of biomarker test. A positive result does not establish an Alzheimer’s diagnosis by itself, and a negative or unclear result may not rule out every possible cause of memory or thinking problems. Results should be interpreted alongside other clinical information.

What Patients May Pay for Dementia Screening

The cost of blood-based Alzheimer’s testing can vary, and some patients may pay hundreds of dollars out of pocket. If enacted, the ASAP Act could allow Medicare to cover eligible blood-based screening tests, subject to Medicare’s existing coverage process. That could make testing more accessible and lead to earlier diagnoses and opportunities to intervene.

Does Medicare Cover Other Alzheimer’s-Related Services?

Medicare already covers certain cognitive assessment and care-planning visits under Part B. During these visits, a health care professional can review cognitive function, establish or confirm a diagnosis, and develop a care plan. Coverage of these services is separate from coverage of an Alzheimer’s blood test, which is the issue addressed by the ASAP Act.

Early Interventions for Dementia

An earlier diagnosis may help people and their doctors evaluate available treatments, manage other health conditions, and consider lifestyle and supportive strategies. For some people with Alzheimer’s disease, newer medications may slow or delay symptoms, although these treatments are not appropriate for everyone and do not cure the disease.

Strategies that may support overall health and quality of life include exercise, nutrition, cognitive activity, and social engagement.

Opportunities for Autonomy

In addition to earlier access to care and interventions, an earlier diagnosis can allow someone the opportunity to make essential legal decisions earlier, preserving their autonomy. Many people delay this kind of planning. A dementia diagnosis can motivate action and inform decisions. Steps to take can include choosing a surrogate decision-maker, updating powers of attorney and advance directives, and creating a plan for housing and care.

Additional Reading

• What’s the Difference Between Alzheimer’s and Dementia?
• Why Estate Plans Need Dementia-Specific Advance Directives
• Living Your Best Possible Life After a Dementia Diagnosis
• Entering and Leaving Medicare Advantage Plans