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How does Medicare cover those with Amyotrophic Lateral Sclerosis (ALS)?

Amyotrophic Lateral Sclerosis (ALS)

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When you have amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), you are automatically enrolled in Medicare Part A and Part B the first month you start receiving Social Security Disability Insurance or disability benefits from the Railroad Retirement Board. As soon as you get your ALS diagnosis, submit your application for disability benefits from the proper authority (Social Security or the Railroad Retirement Board, as relevant). You will be subject to a waiting period of five months before your disability benefits will begin. It does not matter how old you are: if you are under 65, you are still eligible to receive Medicare benefits. State that you have ALS on your application for disability benefits.

Qualify for Medicare

Medicare beneficiaries with ALS qualify for premium-free part A.

When you sign up for Medicare, you will sign up for a Part D prescription drug plan to help offset the costs of prescription drugs. Depending on what state you live in, you may not qualify for a Medicare Supplement (Medigap) plan if you are under the age of 65. Insurance companies are not required to sell Medigap plans to people under 65. If you are able to enroll in one of these plans, you may be subject to a higher premium rate due to your age.

There are no rules limiting your access to Medicare Advantage (Part C) plans. You can enroll in a Medicare Advantage plan once you are enrolled in part A and Part B and if you live within the plan’s service area. Medicare Advantage plans give you the same standard coverage as Part A and Part B with additional coverage options for prescription drugs, dental, vision, or hearing care in most cases. The prescription drug coverage is comparable to Medicare Part D prescription drug plans. Part C plans have out-of-pocket limits, which is not the case with Original Medicare. If you have high expenses due to your treatment and prescription drugs, a Part C plan may be the right choice. You can choose to enroll in either a Medicare Advantage or Medigap plan, but you cannot have both.

Medicare Part B covers durable medical equipment, which includes communications devices for patients with ALS. Basic communication tools are covered, as are the basic forms of upgradable tools. Thanks to the Steve Gleason Act, Medicare has permanent funding for communication devices such as eye-tracking technology and speech generating devices, along with all of their required accessories, for ALS patients.
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