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.
Speak to a Licensed Agent Today
1-800-991-4407 / TTY 711
Mon-Thu 8am-11pm, Fri 8am-9pm, Sat 10am-6pm EST
e-TeleQuote Insurance Inc. (“e-TeleQuote”), an affiliate of Primerica, Inc., does business as easyMedicare® in all states other than California, Florida and New Mexico. e-TeleQuote is a duly licensed insurance agency appointed by Medicare Advantage HMO, PPO and PFFS plans and stand-alone prescription drug plans and insurance companies holding Medicare contracts approved by The Centers for Medicare & Medicaid Services (CMS). e-TeleQuote is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Enrollment in any plan for coverage is subject to insurance company approval. Enrollment in the plan depends on the plan’s contract renewal with Medicare. By using e-TeleQuote’s easyMedicare website, you understand and agree that in California, Florida and New Mexico, we operate as e-TeleQuote Insurance, Inc. (Your IP address and/or location coordinates may be gathered to verify your location.) Sales agents/producers may be compensated based on your enrollment in a health plan. Medicare Supplement plans are not connected with or endorsed by the U.S. Government or the Federal Medicare program. e-TeleQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. easyMedicare.com is a non-government site, powered by e-TeleQuote Insurance, Inc. e-TeleQuote provides a secure way to purchase Medicare insurance from the comfort of your home or workplace. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800–MEDICARE to get information on all of your options. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.
Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M