At Cross Insurance Services, it’s our job to make understanding Medicare and Medicare enrollment easy. If you have Amyotrophic Lateral Sclerosis (also known as ALS or Lou Gehrig’s Disease), there are a few important things to know.
Automatic Enrollment
Generally, Medicare enrollment eligibility begins three months before the month you turn 65. Individuals receiving disability insurance may enroll early, although Medicare requires a 24-month delay after recipients begin receiving disability benefits. That’s not the case if you have ALS, as eligibility as a result of disability can happen at any age. Unlike other disabilities, for those with ALS, Original Medicare coverage begins with your disability benefits.
If you have ALS, you should receive a Medicare card in the mail when disability benefits through Social Security begin paying out. This card is red, white and blue and states your Medicare Number, which you will need if you choose to enroll in a Medicare Advantage, Medicare Supplement Insurance (Medigap), or Prescription Drug plan.
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Original Medicare Coverage
There are a few options for coverage when talking about Medicare, but you are automatically enrolled in Original Medicare when you start receiving disability benefits. The coverage for Original Medicare includes:
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Part A
Medicare Part A covers hospital-related care and costs
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Part B
Medicare Part B covers doctor visits, durable medical equipment, and medically-necessary care
Original Medicare (Parts A and B) doesn’t include coverage for prescription drugs. If you need or want coverage for prescription medications, you will need to enroll in an additional Medicare Prescription Drug plan. Additionally, if you are enrolled in Original Medicare, you will pay a Part B premium and deductibles for both Parts A & B out of pocket. After meeting your Part B deductible, you will be responsible for the remaining 20 percent of Part B services that Medicare doesn’t cover. Expenses for specialized services and physicians can add up quickly, which is why many people choose to look toward Medicare Advantage.
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Additional benefits through Medicare Advantage
Original Medicare (Parts A and B) does not include coverage for numerous important benefits that individuals with ALS may desire, including:
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Vision
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Dental
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Hearing
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Prescription Drugs
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Home Health Care Services
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Fitness
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Transportation to and from medical appointments
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A budget for over-the-counter medical purchases
Medicare Advantage plans – offered by private insurance companies – include your Original Medicare coverage and may include many of these additional benefits in a single convenient plan. If you have ALS, you may find a Medicare Advantage plan to be more cost effective than Original Medicare. Many Medicare Advantage plans offer low-to-no premiums, deductibles and copays/coinsurance. Additionally, because Medicare Advantage plans often include Part D prescription drug coverage, obtaining your medication may be more financially friendly and convenient.
Special Needs Plan Eligibility
Some Medicare Advantage plans are designated as Special Needs Plans (SNPs). These plans are only open to individuals with certain conditions or situations, such as a neurological disorder. Special Needs Plans generally offer benefits specific to the condition they are designed for or include additional specialists in the plan network.
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Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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Further Reading:
What is Medicare Part D? | Prescription Drug Plans
Medicare Caregiver | Caregivers Through Medicare
