At easyMedicare, it’s our job to make understanding Medicare and Medicare enrollment easy. If you have Amyotrophic Lateral Sclerosis (also known as ALS or Lou Gehrig’s Disease), there are a few important things to know.
Generally, Medicare enrollment eligibility begins three months before the month you turn 65. Individuals receiving disability insurance may enroll early, although Medicare requires a 24-month delay after recipients begin receiving disability benefits. That’s not the case if you have ALS, as eligibility as a result of disability can happen at any age. Unlike other disabilities, for those with ALS, Original Medicare coverage begins with your disability benefits.
If you have ALS, you should receive a Medicare card in the mail when disability benefits through Social Security begin paying out. This card is red, white and blue and states your Medicare Number, which you will need if you choose to enroll in a Medicare Advantage, Medicare Supplement Insurance (Medigap), or Prescription Drug plan.
Original Medicare Coverage
There are a few options for coverage when talking about Medicare, but you are automatically enrolled in Original Medicare when you start receiving disability benefits. The coverage for Original Medicare includes:
- Part A: This includes inpatient/hospital coverage. For example, care at a hospital, nursing facility, hospice and eligible home health services. Other covered services include medically necessary equipment or services to treat your condition.
- Part B: This includes outpatient/medical coverage. For example, medical equipment, lab tests, ambulance services, mental health care and preventative services.
Original Medicare (Parts A and B) doesn’t include coverage for prescription drugs. If you need or want coverage for prescription medications, you will need to enroll in an additional Medicare Prescription Drug plan. Additionally, if you are enrolled in Original Medicare, you will pay premiums and deductibles out of pocket. After meeting your deductible, you will be responsible for the remaining 20 percent that Medicare doesn’t cover. Expenses for specialized services and physicians can add up quickly, which is why many people choose to look toward Medicare Advantage.
Additional benefits through Medicare Advantage
Original Medicare (Parts A and B) does not include coverage for numerous important benefits that individuals with ALS may desire, including:
- Prescription Drugs
- Home Health Care Services
- Transportation to and from medical appointments
- A budget for over-the-counter medical purchases
Medicare Advantage plans – offered by private insurance companies – include your Original Medicare coverage and may include many of these additional benefits in a single convenient plan. If you have ALS, you may find a Medicare Advantage plan to be more cost effective than Original Medicare. Many Medicare Advantage plans offer low-to-no premiums, deductibles and copays/coinsurance. Additionally, because Medicare Advantage plans often include Part D prescription drug coverage, obtaining your medication may be more financially friendly and convenient.
Special Needs Plan Eligibility
Some Medicare Advantage plans are designated as Special Needs Plans (SNPs). These plans are only open to individuals with certain conditions or situations, such as a neurological disorder. Special Needs Plans generally offer benefits specific to the condition they are designed for or include additional specialists in the plan network.
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Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M