Medicare

Can Medicare Help With ALS?

ALS is a debilitating neurodegenerative disease that results in the body’s loss of muscular control. As soon as a person has been diagnosed with ALS, they become eligible for Original Medicare coverage plus any supplement plans that are open to them.

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Amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s Disease, is a neurodegenerative disease characterized by a loss of muscle control that starts in the cells of the body. The results are devastating, with the patient eventually losing the ability to speak, eat, move, and breathe for themselves. While scientists have yet to find a cure for the debilitating disease, patients and their families are provided some financial relief through Original Medicare (Parts A and B) and any supplemental Medicare plans for which they’re eligible.

Can Medicare Help With Amyotrophic Lateral Sclerosis (ALS)?

According to the ALS Association, legislation passed in late 2020 made those diagnosed with ALS eligible to receive Medicare benefits as soon as their diagnosis has been made. Once the patient is enrolled in Medicare, they have access to all of the benefits and resources that are usually reserved for those over 65 years of age. This includes home health services, durable medical equipment, plus support staff like skilled nurses and therapists.

When are ALS Patients Eligible for Medicare?

As of late 2020, patients can apply for Medicare immediately after diagnosis and receive coverage as long as they’re over the age of 18 or meet the work history required to be eligible for Medicare.

Before 2020, those diagnosed with ALS had to wait 24 months before enrolling in Medicare and had to receive social security income benefits for an additional 5 months before being eligible for full Original Medicare coverage.

Is Home Health Care for ALS Patients Covered Under Medicare?

Patients are eligible to receive covered home healthcare services under Medicare Part B as long as the patient meets regularly with their primary care doctor and meets all other requirements to receive the service. Patients must enact a care plan that was established with their primary care provider and their skilled nursing and therapy services teams. It must be established that they are homebound and can’t leave their house without considerable effort, support, or support resources. 

Does Medicare Cover Wheelchairs or AFO Braces for ALS Patients?

Medicare will cover wheelchairs and ankle foot orthosis braces, or AFO braces, for patients when medically necessary. Because this equipment falls under the durable medical equipment (DME) category, any supplier the patient chooses must also be enrolled in Medicare for the equipment to be covered.

Are ALS Patients Eligible for Medicare Advantage and Medicare Part D?

Those with ALS are eligible for Medicare Part D and can enroll when they enroll in Original Medicare. Medicare Part C or Medicare Advantage, however, might be more difficult for someone under the age of 65 to enroll in as the requirements for this part are more stringent. Whether an ALS patient can enroll in Medicare Part C before the age of 65 is primarily up to each state and the requirements laid out for their plans.