How can Medicare Supplement help with ALS?

Last Updated : 09/16/20183 min read

ALS, or amyotrophic lateral sclerosis, is a progressive neurogenerative disease, according to the ALS Association. ALS attacks motor neurons and results in progressive muscle weakness and eventually leads to ventilator support for breathing. There is no cure for ALS and the disease is fatal, according to the Mayo Clinic.

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Mean survival time of ALS is three to five years according to the ALS Association.

Does Original Medicare help people with ALS?

People with ALS atomically get Original Medicare (Part A and Part B) the month their Social Security disability benefits start. People with most other types of disabilities generally have to wait 24 months for Original Medicare coverage. Medicare Part A covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services. Part B covers outpatient care, durable medical equipment, ambulance services and mental health.

Neither Medicare Part A nor Part B have an out-of-pocket maximum, meaning there is no limit on the amount of money you may personally spend on covered services. A Medicare Supplement (Medigap) plan sold by a private insurance company may cover some of the costs that Original Medicare doesn’t cover such as copayments, coinsurance and deductibles.

What does Medicare Supplement cover?

In general, all Medicare Supplement plans cover the following benefits:

  • Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
  • Medicare Part B coinsurance or copayment*
  • Blood (first 3 pints)*
  • Part A hospice care coinsurance or copayment*

*Medicare Supplement coverage may be partial for some plans.

Some types of Medicare Supplement plans also cover:

  • Skilled nursing facility care coinsurance
  • Medicare Part A deductible
  • Medicare Part B deductible
  • Medicare Part B excess charges (the amount that a non-participating provider may charge above the Medicare-approved cost for a service)
  • Foreign travel emergency (up to plan limits)

If you frequently visit the doctor or have a long stay in the hospital, a Medicare Supplement plan may save you significant out-of-pocket costs.

Does Medicare Supplement help people with ALS?

Federal law doesn’t require private insurance companies to sell Medicare Supplement plans to people under age 65. Most people who develop ALS are diagnosed between the ages of 40 and 70 with the average age being 55 at the time of diagnosis, according to the ALS Association. Since only ten percent of people affected with ALS live more than 10 years, it’s unlikely that a person diagnosed with ALS at age 55 will still be alive on his 65th birthday. Despite the relatively short life expectancy of people with ALS, the federal government does not give people under 65 with ALS a special right to buy a Medicare Supplement plan.

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However, some states require private insurance companies to sell Medicare Supplement insurance to people under 65. Your options for Medicare Supplement policies may be more limited and you may have to pay more than someone who is 65 or older.

These states require the insurance companies to offer at least one kind of Medicare Supplement policy to people with Medicare under 65:
California* Maryland Oklahoma
Colorado Massachusetts Oregon
Connecticut Michigan Pennsylvania
Delaware Minnesota South Dakota
Florida Mississippi Tennessee
Georgia Missouri Texas
Hawaii New Hampshire Oklahoma
Illinois New Jersey Vermont*
Louisiana New York Wisconsin
Maine North Carolina

* A Medicare Supplement policy isn’t available to people with ESRD under 65.

Do you have more questions about Medicare Supplement for people with ALS?

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