Amyotrophic lateral sclerosis, ALS, or Lou Gehrig’s disease, is the most common adult-onset motor neuron disease in the United States. Every year medical professionals diagnose around 5,000 new cases in this country.
ALS is a group of rare, progressive neurodegenerative diseases that affect brain and spinal cord nerve cells that control the body’s voluntary muscle movement. With progression of this disease, muscles become weaker, and those with ALS experience increasing difficulty with movement, speech, and other basic abilities like chewing and swallowing.
People with ALS eventually lose the ability to care for themselves, making supportive care an absolute necessity. If you have been diagnosed with ALS, or are caring for someone with ALS, it is important to know what sort of care you need and whether your Medicare insurance covers the cost of this care.
ALS Care
Currently, there is no cure for ALS, but there are treatments available to assist with symptom control and reduction of possible complications. There are also services available to help make daily life more comfortable.
People living with ALS are benefited by taking part in physical and occupational therapy. A physical therapist shows them ways to exercise so they can strengthen muscles, boost cardiovascular health, and gain better mobility. Exercises like these help them stay safe and independent for as long as possible. Occupational therapists assist patients with equipment they can use to save energy and to maintain mobility.
Speech therapy is another treatment commonly suggested for people with ALS. Speech therapists help patients learn ways to speak more clearly and with more volume. This allows them to maintain their communication skills for a longer period during the progression of ALS.
As ALS progresses, the muscles that assist breathing get weaker. Your health care provider may suggest that you have treatment with noninvasive ventilation. NIV is a system that provides air and oxygen under positive pressure. You use either a face mask or a nose mask and the system works to boost your normal breathing.
Drug treatments that health care providers usually prescribe for people with ALS include medications that may slow the progression of ALS, help to decrease the body’s decline, and assist in relieving common symptoms like muscle cramping, pain, depression, sleep problems, and constipation.
How Does Medicare Cover ALS Care?
If you have ALS, your care may be covered by different parts of your Medicare benefits. Original Medicare Part A (hospital insurance) covers inpatient hospital care, skilled nursing facility care, hospice, and certain home health care services. It also covers lab tests and surgery when you are formally admitted as an inpatient.
Original Medicare Part B (medical insurance) coverage includes the services of health care providers, outpatient care, durable medical equipment, other home health care services, and some preventive services.
Your prescription drugs are covered by a Medicare Part D policy. This is stand-alone coverage that you purchase from a Medicare-approved company. Each insurance company has its own formulary, or list of drugs that they cover. The drugs you need may or may not be on your company’s formulary. If you are not sure about your drug, speak with an agent from your insurance provider.
Having help with care in the home is important for people with ALS. It is comforting to remain in familiar surroundings with family members and friends close by. Medicare covers some services under home health care if they are intermittent and they are medically necessary.
This home health care coverage includes:
• Skilled nursing care
• Physical, occupational, and speech therapies
• Home health aides
• Medical social services
• Medical supplies
As a Medicare recipient living with ALS, to be eligible for coverage of these services under Medicare Parts A or B, or through a Medicare Advantage (Part C) plan, you must meet the following requirements:
• Your physician must order the services and include them in a certified plan of care after meeting with you personally.
• You must be homebound.
• A Medicare-approved home health agency must provide the services listed above.
• Your care plan must be recertified every 60 days.
For more information about Medicare coverage for ALS care, you can get details from your health care provider or a licensed agent representing your insurance provider.
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