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Medicare through Social Security
Disability
Social Security Disability income is available to those with ALS who are no longer working. Before the July 2001 ALS amendment was in effect, persons with ALS had to wait the customary 24 months before becoming eligible for Medicare benefits. With the new legislation, once a person with ALS is approved for Social Security Disability, that 24-month waiting period is waived and they are eligible for Medicare benefits. (It is important to note that the Social Security Disability process takes approximately 5 months.)
What does being eligible for Medicare mean for someone living with ALS? What coverage will you be entitled to and how can it help? Medicare is a fairly simple program divided into two parts, Part A and Part B. Part A covers hospital stay, home health, skilled nursing and hospice benefits. Medicare Part A is typically premium free with an 80% coverage on most services. Part B covers doctor services, durable medical equipment, some home health care, ambulance services, outpatient rehabilitation facility care (including physical, occupational and speech therapy) lab and x-ray services, blood and medical supplies, and other outpatient services. Part B carries a fee of $50 a month that is automatically deducted from the Social Security Disability income you receive. If you do not want Part B of Medicare, you must let the government know by responding to the Medicare letter the government sends to you in the mail. Medicare Coverage is provided in two ways: directly through the government as Original Medicare or through private Medicare plans that contract with the federal government to provide services.
There is also an option to buy what is called a Medigap policy to fill some of the gaps in services and costs that Original Medicare does not cover. Medigap is a plan that you can purchase from a private insurance company to supplement Original Medicare. There are ten standardized plans in the Medigap program with all the plans offering a core set of benefits including hospital coinsurance coverage, 365 dyas of full hospital coverage after you exhaust the 150 days of coverage you get under Original Medicare, coinsurance on your doctors and other medical bills. Depending upon what plan you choose, other benefits can include skilled nursing, emergency care outside the U.S., Part B excess charges and limited prescription drug coverage. All of these Medigap plans cost more than Original Medicare and you should carefully research all plans when considering additional coverage.
I hope this brief description of Medicare has been helpful to you. For further information on different options regarding Medicare, please refer to the following references:
- 1-800-MEDICARE (633-4227)
- Government Hotline 1-800-333-4114
- www.medicare.gov – Government Website
- www.medicarerights.org – Medicare Rights Center Website
Additionally there are social service providers at MDA sponsored clinics that can assist you should you need additional help.
As always, please do not hesitate to contact me if you have any questions regarding MDA Services at 212-689-9040 or newyorkcityservices@mdausa.org
Warm Regards and Happy Holidays!
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