How Does Medicare Handle ALS Coverage

Amyotrophic Lateral Sclerosis (ALS) affects as many as 30,000 Americans in any given year. The risk of ALS increases with age, most commonly developing in those between the ages of 40 and  mid-60s. So, since an estimated 51% of people who have it are older than 70 years, it’s important to understand how Medicare covers this disease, in case it affects your life. 

ALS Explainedillustration of a brain with a hand holding a magnifying glass over it

ALS, also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. Around 5 to 10% of all ALS cases are familial, meaning they have been inherited from a parent. The familial form usually only requires one parent to be a carrier of the disease, which is caused by mutations in more than a dozen genes.

ALS will often start in the hands, feet, or limbs, and then spread to other parts of the body, and will usually begin with muscle twitching, weakness, or slurred speech. As it advances, nerve cells are destroyed, creating weaker muscles that will eventually affect chewing, swallowing, speaking, and breathing. Unfortunately, there is no cure for ALS. 

Risk Factors

  • Family members with the disease-  5-10% of people with ALS inherited it from a parent.
  • Age– Risk increases with age; diagnosis is most common between the ages of 40 and mid-60s.
  • Sex- More men under the age of 65 develop ALS than women in the same age group, but after age 70, the difference between the sexes disappears.
  • Genetics– Some studies examining the entire human genome have found many similarities in the genetic variations of people with familial ALS and some people with non-inherited ALS
  • Smoking

ALS & Medicare

If you are diagnosed with ALS, no matter if you’re 65 or not, you can enroll in Medicare once you are also receiving Social Security disability benefits. In the past, if you were younger than 65 and were diagnosed with ALS, you were required to undergo a 5-month waiting period to get your  Medicare and SSDI benefits. As of July 23, 2020, though, people with ALS no longer have to wait five months, and are eligible for automatic enrollment into Medicare Parts A and B the first month they receive SSDI.

Extra Coverage Options

illustration of hands over a person

If you’re a Medicare enrollee with ALS, you can choose a Medicare Part D Plan when you become eligible for Medicare, which will help with the cost of prescription drugs. But, you also have the option of purchasing a Medicare Supplement Plan, which can help pay for the things that Medicare does not, including the 20% coinsurance that you will have to pay out-of-pocket for every Part B expense. One of these plans could cover 100% of your Part A coinsurance and hospital costs, as well as 100% of Part B coinsurance and copayments, for one low monthly premium price. 

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans in minutes for you at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

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