Medicare is the primary source of health insurance for senior citizens in America and for people with permanent disabilities. The national healthcare program has evolved over the years but it works like any other health insurance. Most Medicare plans cover a portion of the cost of necessary medical services but in some cases such as chronic diseases like Multiple Sclerosis (MS), it may require cost-sharing.
What Is MS?
MS, or Multiple Sclerosis, is a widespread neurological disease that causes disabilities in the affected patients. It occurs when the patient’s immune system attacks their Central Nervous System by targeting the substance that forms a protective coating around the nerve fibers. The disease is progressive with no proper cure available as of now.
There are nearly one million people in America that are living with MS. Although MS can develop at any age, it’s usually diagnosed in people between the ages of 20 to 50, most of them being females. 20% of MS patients have a less severe MS condition where the disease progresses slower and the symptoms are less harsh. The aggressive form of the disease affects over 15% of the people with severe symptoms and few or no periods of remission.
How Is MS Diagnosed?
There’s no particular test that can determine whether you have the disease. Certain symptoms alert the doctor who’ll then recommend doing a physical exam including blood tests, spinal tap, and an MRI of the spinal cord and the brain. This will help identify any presence of sclerosis, lesions, or abnormal structures that may indicate the existence of the disease. This will also help in assessing the level of progress of the disease and the care and treatment that may be required.
MS and Medicare
The treatment for MS can be rather costly as with any chronic disease requiring extensive care. The average cost of treatment for most people with MS is around $8,500 to $55,000 per year.
This leads to the question of how much of the cost is covered in Medicare. There are certain conditions that need to be met in order to qualify for Medicare with an existing MS condition;
- You are aged 65 or older
- You are a permanent U.S. resident for over 5 years or have a U.S. citizenship.
- You’ve been receiving SSDI (Social Security Disability Insurance) for more than 24 months, even if you are less than 65 years of age.
- You are a Railroad Retirement Benefits recipient
- You have end-stage renal disease that has been officially diagnosed.
- You’ve been approved for SSDI due to amyotrophic lateral sclerosis,in which case you don’t have to wait for 24-months before qualifying for Medicare.
There’s a common confusion among people where they think long-term illnesses and chronic conditions, which require extensive care are not covered in Medicare. However, that’s not the case. Government regulations explicitly clarify that certain services that are necessary to maintain chronic illnesses should be covered in most Medicare plans. This may include therapy, medical equipment, treatments, and skilled nursing, among other requirements.
MS Coverage
In case you have MS, your Medicare plan usually covers the diagnostics tests and doctors’ visits that you need to determine whether you have the disease. Part B of your Medicare plan covers 80% of the costs and the rest can be filled by an additional medicare supplement plan.
Depending on the Medicare plan you chose it may also cover other medical services such as nursing facilities, outpatient treatments such as plasma exchange, medication such as injections or IV infusions, and durable medical equipment (DME) from specially contracted suppliers for Medicare.
If you have any other questions regarding multiple sclerosis and Medicare coverage, contact the licensed Medicare consultants at Seniors for Medicare. We are the leading Medicare advisory service currently associated with multiple insurance coverage providers based in New York and New Jersey. Call us today to find out more about different plans that might be suitable for your medical condition.
Seniors for Medicare 