What Does Medicare Cover For ALS Patients?
- It can be confusing to negotiate Medicare plans. Read on to learn about what Medicare covers for individuals with Amyotrophic Lateral Sclerosis (ALS).
For individuals with Amyotrophic Lateral Sclerosis (ALS), Medicare provides a number of health care benefits. The age of the patient is not relevant, and patients may enroll in Medicare without regard to the length of a disability status.
What Is ALS?
Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease or motor neuron disease, is a progressive neurodegenerative disease that affects nerves in the brain and spinal cord. Motor neurons run throughout the body from the brain and spinal cord to the muscles. As motor neurons gradually die due to ALS, the brain becomes unable to initiate and control muscle movements. Eventually, people may lose the ability to speak, eat, move and breathe.
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Does Medicare Cover ALS?
Individuals with ALS qualify for Medicare before age 65. If you qualify for Original Medicare (Part A and Part B), you may be able to qualify for a Medicare Advantage (Part C) plan. These plans replace Parts A and B and sometimes include additional coverage for services such as vision, hearing, and dental.
What Does Part A Medicare Cover?
Most individuals with ALS qualify for Part A Medicare. Part A typically covers:
- Inpatient hospital care
- Home health care
- Short term care in a post-acute facility, but not long-term care or assisted living
- Skilled nursing facility care
What Does Part B Medicare Cover?
Part B typically covers:
- Medically necessary services needed to diagnose and treat a condition
- Preventative services
- Limited drugs
- Limited mental health care
- Emergency and non-emergency medical transportation
When Do ALS Patients Become Eligible for Medicare?
In most cases, people who qualify for Medicare before age 65 based on a disability must have had a diagnosis and been disabled for 24 months. However, individuals diagnosed with ALS can get Medicare as soon as their disability benefits are approved by the Social Security administration. Individuals are encouraged to submit their applications to Social Security as soon as they have been formally diagnosed.
Does Medicare Cover Home Health Care for ALS patients?
Many people assume that Medicare will cover most of their home health care costs. However, Medicare only pays for home health care on a short-term basis when it's considered medically necessary.
Medicare will not pay for:
- Round-the-clock care
- Homemaker services such as laundry and cleaning
- Personal care services such as bathing and grooming
- Meal delivery services
What Is the Medicare Waiting Period for Patients With ALS?
Patients with ALS are not required to wait the usual 24 months after diagnosis. You will be enrolled in Medicare the first month you receive Social Security Disability Insurance (SSDI) or a railroad disability annuity check. Once you have submitted your completed application to Social Security, you will have a 5-month waiting period before your disability benefits begin.
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