Medicare coverage is available for amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Individuals with ALS may receive health care benefits through Medicare. Patients with this chronic condition may enroll in Medicare without any age restrictions. The 24-month period of disability before coverage doesn’t apply in these cases. Original Medicare provides beneficiaries with coverage for health care services. The services must be medically necessary for treating 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.
However, ALS and ESRD are the only disabilities to which 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 home health care services. 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 seven days a week or less than eight hours a day. Care may be for up to 21 days or less. Additionally, beneficiaries must use a home health care company that Medicare approves for coverage 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.
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.
FAQs
How to Find Medicare Coverage for Lou Gehrig's Disease
If you have questions about pre-existing medical conditions such as Lou Gehrig's disease and how it affects your insurance coverage, we’re here to help! Senior healthcare is our specialty. Our mission is to help you obtain the best health insurance benefits no matter your current health status. We can provide additional information about Medicare coverage. To start the process, call the phone number above or fill out our online rate comparison form. Our team of licensed agents is ready to help with all your insurance needs.
Are there any Gap or D policies that cover Radicava at home?
Hi Christine – we would recommend talking to your doctor about coverage for Radicava infusions at home.
Hi there – does Medicare/Medicaid cover the cost of full-time assisted living (whether in home or at a facility)?
Hi Janae, Medicare does not cover the cost of assisted living or custodial care.
MY SISTER HAS ALS! DOES MEDICRAE PAY FOR MEDICATIONS?
Hi Janice! Part B will cover medications given in an outpatient setting. Part D will cover the prescription medications you pick up at your local pharmacy.
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?
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.
How does a ALS person file a claim for reimbursement for a lift chair we had to purchase.
Hi Jack! You can find out how to file a reimbursement claim here.