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What Does Medicare Cover for ALS Patients

Medicare coverage for Amyotrophic Lateral Sclerosis (ALS) is available. Individuals with ALS may receive health care benefits through Medicare. Patients with these chronic diseases may enroll in Medicare without any age restrictions. The 24-month period of disability before coverage starts doesn’t apply in these cases. Original Medicare Parts A and B provide beneficiaries with coverage for health care services. They must be medically necessary for treating or maintaining a health condition. Part A covers most inpatient hospital services, while Part B covers outpatient services and diagnostic tests.

When are ALS Patients Eligible for Medicare?

Social Security Disability benefits begin five months following a patient’s initial “disability” classification from their healthcare provider. Therefore, it’s important to submit applications to either Social Security or the railroad retirement board immediately after receiving this diagnosis.

Although, ALS and ESRD are the only qualifying disabilities this rule applies. Other disabling health conditions may require individuals to receive SSDI benefits for 24 months prior to becoming eligible.

Does Medicare Cover Home Health Care for ALS Patients?

In most cases, Part B covers the cost of many home health care services and benefits. Members must meet all the requirements before receiving coverage for care. All beneficiaries needing health care services at home must be under the care of a physician who they regularly visit. Doctors or other health care providers must create a care plan for patients, such as those with ALS. A care plan should establish regular services a patient receives. Additionally, providers must regularly review care plans.

Beneficiaries must have certification from their healthcare provider stating that they’re bound to their home. Meaning, they can’t leave without extensive effort and/or assistance.

Intermittent skilled nursing care or therapy services must be medically necessary to qualify for coverage. Therapy includes physical, occupational, and speech-language pathology services.

Intermittent care is for less than 7 days a week or less than 8 hours a day. Care may be for up to 21 days or less. Although, beneficiaries must use a home health care company that Medicare approves for it to cover the costs of services.

Can ALS Patients Enroll in Medicare Advantage?

Beneficiaries under Medicare Advantage plans must use providers within the plan’s network. Referrals for specialist visits may also be a requirement under many Advantage policies. Members may also have similar out-of-pocket expenses like premiums, deductibles, and copays/coinsurance costs.

Can ALS Patients Enroll in Part D?

Enrollees can choose an appropriate Medicare Part D plan as soon as they’re eligible for Medicare. Due to the nature of Lou Gehrig’s disease, prescription drugs are necessary to maintain the patient’s quality of life and health condition. Part D Prescription Drug plans can help pay for these drugs or lessen the cost.

How to Find Medicare Coverage for Amyotrophic Lateral Sclerosis

If you have questions about pre-existing medical conditions such as ALS and how it affects your insurance coverage, we’re here to help! Senior healthcare is our specialty. Our personal mission is to help you achieve the best health insurance benefits no matter the current health status. We can provide extra information about Medicare coverage. All you must do is make a simple phone call.

Give us a call today, or you can fill out our online rate comparison form. Our team of licensed agents is ready to help with all your insurance needs.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

4 thoughts on “What Does Medicare Cover for ALS Patients

  1. How do I find out if an eye tracking computer device that provides a voice communication is covered. Is there a list of these products that are covered?

    1. Hi Gary! Your best option is to contact Medicare directly. More than likely, there is not going to be a list that includes this that you’ll be able to find online.


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