Medicare is the national health insurance program to 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 with ALS, regardless of age.
People with ALS who receive Social Security Disability Insurance are eligible for Medicare. There is much to know about what is and is not covered. Thanks to the Center for Medicare Advocacy, 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 age 65 and older and their spouses
Persons eligible for SSDI, including people with ALS (thanks to ALS advocacy efforts, in 2001, the usual 24-month waiting period for Medicare was eliminated for SSDI recipients disabled by ALS; Medicare entitlement now begins the first month the recipient receives cash benefits (approximately 5 months after an individual is deemed disabled).
Coverage under Medicare is similar to 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 healthcare. 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.
To better understand Medicare in more detail, go 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.