Medicare is the national health insurance program for which all Social Security recipients who are either over 65 years of age or permanently disabled are eligible. Thanks to tireless ALS advocacy work, this incudes people living with ALS, regardless of age.
People living with ALS who receive Social Security Disability Insurance (SSDI) are eligible for Medicare. There’s much to know about what is and isn’t covered. Thanks to the Center for Medicare Advocacy (CMA), many informational resources are available through the Medicare and ALS Access Program which can be accessed in more detail from this webpage.
Medicare in Summary
Medicare is the national health insurance program available to:
- Persons aged 65 and older and their spouses.
- Persons eligible for SSDI. (Thanks to ALS advocacy efforts, people with ALS are eligible for Medicare benefits due to disability immediately following an application for SSDI due to ALS. Learn more.)
Coverage under Medicare is like that provided by private insurance companies: it pays a portion of the cost of medical care. Often, deductibles and co-insurance (partial payment of initial and subsequent costs) are required of the beneficiary.
Medicare has Two Main Parts: Part A and Part B
Part A (Hospital Insurance) helps pay for:
- Care in hospitals as an inpatient, skilled nursing facilities, hospice care and some home health care. This coverage is free to SSDI recipients.
Part B (Medical Insurance) helps pay for:
- Services provided by doctors and other health care practitioners, home health care services, durable medical equipment and some hospital outpatient care services. There is a monthly premium for this coverage.
In addition to premiums, Medicare beneficiaries share the cost of the program with the government through deductibles and co-payments for many of the services.
What is Medicare Advantage (Part C) and Part D?
Medicare beneficiaries have the option to receive their Medicare benefits through private health insurance plans. These private insurance options are authorized by Medicare Part C, which is also called Medicare Advantage (MA). These are typically managed care plans that:
- Require patients to obtain services only from certain providers;
- May offer reduced premiums, deductibles and coinsurance payments, and/or additional benefits not offered in traditional Medicare; and
- May also include Part D -Part D is the Medicare prescription drug benefit.
Help With Medicare Co-Pays And Other Expenses
Beneficiaries with limited incomes may be eligible for help from federal and/or state programs (“Medigap") to cover some or all of Medicare’s required co-payments and to help with prescription drug costs.
Medigap health insurance can be purchased to cover some of Medicare’s co- insurances and deductibles.
Medicare Open Enrollment
Every year from October 15 to December 7, Medicare beneficiaries are able to reevaluate their coverage and make changes to their plan. During this time, known as Medicare Open Enrollment, you can change coverage between Original Medicare and Medicare Advantage plans and make changes to your Part D Prescription Drug coverage. Coverage changes outside of this timeframe are only available if there is a qualifying life event.
This resource has more information about Medicare Open Enrollment and understanding the options available to you.
To better understand Medicare in more detail, go to our Resources section. From this page, you can access numerous resources and register to view webinars on Medicare and ALS with an emphasis on the home care benefit.
For more information, including the number for the ALS Insurance and Benefits Resource Line, click here.