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Coordinating Medicare and VA Benefits for People with Parkinson’s Disease

Over 10 million people worldwide are living with Parkinson’s Disease. One population at higher risk for developing the condition are Veterans. Many Veterans who served in the Vietnam War were likely exposed to Agent Orange, a toxic herbicide used during the war. Agent Orange has been found to cause Parkinson’s disease, among several other chronic illnesses. 

If you have already been diagnosed, or believe you have Parkinson’s disease, Medicare and the VA will cover many services, tests, and procedures to help you maintain your illness.  

Understanding Parkinson’s Disease

Parkinson’s is a progressive disease that affects the central nervous system over time. There are 5 stages used to describe the advancement of the disease.

  • Stage 1: Mild symptoms like tremors, changes in posture, and other movement symptoms may occur on one side of the body. Activities of daily living are generally not affected yet.
  • Stage 2: Increased tremors and rigidity worsen as it affects both sides of the body. Mobility issues are present, and daily activities are more challenging for the person.
  • Stage 3: Referred to as “Mid-Stage,” where motor symptoms worsen, and loss of balance is prevalent. The ability to perform daily living activities is somewhat restricted, and disability is moderate.
  • Stage 4: Symptoms are considered severely disabling, and the use of a mobility aid is highly suggested for safety reasons. Unable to perform most activities of daily living or live independently. 
  • Stage 5: Leg stiffness and rigidity will make standing or walking impossible and may result in wheelchair or bed confinement. The person is unable to perform any daily living activities and requires constant care.

Parkinson’s causes the deterioration of brain neurons, which decreases dopamine, the chemical responsible for controlling motor skills. Specific causes of Parkinson’s Disease are still unknown. However, some factors like genetics and exposure to certain toxins can increase the likelihood of developing it. 

Treatments for Parkinson’s Disease

Unfortunately, there is no cure for Parkinson’s Disease. The main goal for someone with Parkinson’s is to live with it more comfortably by managing and reducing its symptoms. Treatment plans are individualized, as symptoms can vary from person to person. 

Your provider can recommend several different treatment options, which may include:

  • Prescription medications: Certain medications can help slow the onset of the disease.
  • Exercise: Regular exercise can help with balance, increase mobility, and boost mental health.
  • Surgical treatments: Surgery can help manage symptoms and increase quality of life.
  • Physical, occupational, or speech therapy: These can help regain speech and mobility for those with severe symptoms.

How Medicare Covers Parkinson’s Disease

Original Medicare (Part A and B) covers Parkinson’s-related care, and which Medicare Part you’ll use depends on the service you receive. Medicare Part D (Prescription Drug Coverage) will also cover prescriptions. The premiums, copays, and deductibles for the medications will depend on which private insurer you choose.

Medicare Part A 

Part A (Hospital Insurance) covers the following services:

Although most people do not pay a monthly premium for Medicare Part A, you will be responsible for deductibles, copays, and coinsurance as you use this coverage. 

The Part A deductible is $1,632 per benefit period in 2024. Medicare will pay for your first 20 days in a skilled nursing facility, and then you will have a copay of $204 per day until day 100. Medicare will not pay after you have exceeded 100 days in a skilled nursing facility, and you will be responsible for all costs after that.

For inpatient hospital stays exceeding 60 days, you will pay a daily copay of $408 until day 90; after that, you will pay a daily copay of $816 until you have used all your lifetime reserve days. Once you exhaust your lifetime reserve days, you will pay 100% of the cost for any services.

Medicare Part B

Part B (Medical Insurance) covers the following services:

  • Doctor and specialists’ visits
  • Physical, occupational, and speech therapy
  • Outpatient surgeries or procedures
  • Drugs administered by a physician
  • Diagnostic tests, screenings, and other preventative services
  • Durable Medical Equipment (DME) like wheelchairs and other mobility aids

Part B has a standard monthly premium of $174.70 for 2024. However, some people may pay more due to their income. The annual Part B deductible is $240; afterward, covered individuals will be responsible for 20% of the cost of any Medicare-approved services.

What Medicare Doesn’t Cover

While Medicare covers many services, it is important to know that there are some services it does not cover when it comes to managing your Parkinson’s Disease. Below are a list of services not covered by Medicare:

  • Certain durable medical equipment (i.e., shower chairs or stair lifts)
  • Custodial care for nonmedical activities (i.e., assistance with bathing, cleaning, going to the restroom, etc.) 
  • Long-term care

How Veterans Affairs (VA) Covers Parkinson’s Disease

VA disability benefits are paid to U.S. military Veterans with disabilities sustained while in service. Typically, to qualify for VA disability benefits, you would have to prove your disability or illness was connected to your military service. 

However, since the VA has acknowledged those who served in the Vietnam War were exposed to Agent Orange (which is linked to Parkinson’s Disease), they have created a presumption that allows this group of Veterans to bypass the requirement to show proof that their Parkinson’s is service-related. 

VA disability compensation and VA healthcare are funded and administered by the U.S. Department of Veteran Affairs, which will review claims and determine compensation amounts and disability ratings. They will then assign you a priority group depending on the severity of your disability.

VA Coverage

Veterans with service-related disabilities and those with catastrophic disability ratings of 50% or higher will not pay copays for urgent care, inpatient hospital services, doctor/specialist visits, or medications if they use VA providers and pharmacies.

The VA will also pay for the first 21 days of elder care or long-term care in a 12-month period. After which, copays will apply depending on the level of care needed.

  • Inpatient care: Inpatient care has a copayment of up to $97 per day; this includes short or long-term nursing home stays, overnight respite care, and overnight geriatric evaluations. 
  • Outpatient care: Outpatient care has a copayment of up to $15 per day; this includes care at an adult daycare, daily respite care, and geriatric evaluations that do not require an overnight stay.
  • Domiciliary care: Domiciliary care is available for homeless Veterans and costs up to $5 per day. It includes short-term rehabilitation services as well as long-term maintenance care.

Medicare and VA Coordination of Benefits

Medicare and the VA do not coordinate benefits, so it is important to choose which insurance will best benefit your situation. For the most part, you can only use VA benefits at VA facilities and hospitals. You may use your VA coverage with non-VA providers, but you must obtain a preauthorization to do so, and a copay may apply for non-service-related care.

If you venture outside the VA, it is wise to use your Medicare coverage for all non-VA providers and services as long as they accept Original Medicare. Your Medicare cost-sharing will apply to approved hospital and medical services. Any services that the VA or Medicare does not cover will be your responsibility to pay for.

Getting Help When You Need It

Living with an illness like Parkinson’s Disease is hard enough, let alone the added headache of figuring out insurance. Knowing ahead of time which insurance your provider accepts and whether Medicare or the VA will cover the services will save you time and frustration down the road. Be sure to ask questions and keep good notes each time you see your provider.

If you need help, don’t hesitate to ask for it. The VA has many resources available for Veterans, and Medicare also has free local assistance. You can contact your local VA office or State Health Insurance Program (SHIP) to get assistance with your benefits.  

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You’re just a few steps away from seeing your Medicare Advantage plan options.

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