What Does Medicare Cover for ALS Patients

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.

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.

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.

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.