How Does Medicare Insurance Cover Multiple Sclerosis Treatment?

Multiple sclerosis (MS) is a condition that requires a lot of effort to keep up with. Since we
currently don’t have a cure, the only real option is to treat the disease’s symptoms over its course.
This can be pretty expensive, with doctor’s visits, therapy, and medications, to name only a few
of the regular costs associated with living with multiple sclerosis. If you’re enrolled in Medicare
insurance, however, you may be in luck. In many circumstances, your plan will help you to afford
your diagnosis and treatment of multiple sclerosis.

Diagnosis

If you’re showing signs of MS, your doctor may order some tests to find out if you have the
condition. There are generally three different tests that a doctor may use to diagnose MS —
an MRI scan, spinal tap, or evoked potentials test. Your doctor may also order other tests to
try to rule out other conditions first. The idea of paying for these tests can be daunting. Does
Medicare insurance help pay for them?

Luckily, the answer is generally yes. These types of tests should fall under diagnostic tests,
which Original Medicare (and therefore Medicare Advantage plans) can cover. How much
you’ll owe for them depends on the circumstances of the tests. If your test is given in an
outpatient setting, most likely with an MRI, Medicare Part B should help pay for it. In the
case of a non-laboratory diagnostic test, like an MRI, you’ll owe 20 percent of the Medicare
insurance-approved amount. If you’re given the test in an inpatient setting, Medicare Part A
should help cover it once you’ve reached the deductible. There are other intricacies, such as
extra coverage from Medigap or possibly Medicare Advantage plans, but most of the time,
you can count on Medicare insurance partially covering MS diagnostic tests, at least.

Treatment

With a condition like multiple sclerosis, there are many facets of treatment. If you’re taking a
comprehensive approach to treatment, you’ll have a team of specialists who care for you. To
help you afford this care, the Medicare program may cover 80 percent of your doctor visits after you meet your deductible. This is also true for the specialists you may see as part of your
treatment team.

Most people who receive treatment for MS will get some type of therapy, like physical therapy,
and for good reason. As the disease progresses, attacking the nervous system, it can become
harder to walk or move well. Your doctor may also suggest mental health, occupational, or
speech therapy. The Medicare program generally covers 80 percent of these treatments, and you
owe 20 percent of the approved amount for outpatient treatment. The other major category of
treatment is durable medical equipment (DME), which you may use in your daily life. If you have
Original Medicare, you’ll pay 20 percent of the Medicare-approved amount. This is all after you
reach the Part B deductible.

If you have Medicare Advantage, what you owe will change depending on your individual plan.
Any Medicare Supplement you have may help you afford your deductibles and other costs.

Medications

A major part of treating multiple sclerosis involves medications. These prescription drugs can
be broken up into three main categories — managing symptoms, slowing the condition’s
progression, and treating relapses. Medicare insurance coverage of these medications is a
little hazy since Original Medicare doesn’t really cover prescriptions. There are times when
Original Medicare can cover prescription drugs. This is mainly when someone receives the
medicine at a doctor’s office as part of the visit or when the drugs go with an item of DME,
among other specific circumstances. Medicare Part D plans go with Original Medicare
coverage and can help cover your MS prescriptions. Your other option is to switch to a
Medicare Advantage with prescription drug coverage.

Both Part D and MA plans are approved by the Medicare program but offered by private
companies. This means that plans can differ in what they offer and what they cost. If this is
an option you’re looking into, you’ll want to make sure that the drugs you need are on your
plan’s formulary or work with a licensed sales agent to make sure the plan fits your needs.

Multiple sclerosis treatment is a multi-faceted approach to symptom-care, improving
standard of living, and slowing the progression of the disease. If you receive a diagnosis
as severe as MS, it helps to know that Medicare insurance helps cover your tests and
treatments. Your focus can be on more important things than finances.

Read More: https://www.nationalmssociety.org/resources/financial-planning/healthinsurance/
medicare
Not affiliated or endorsed by Medicare or any government agency.