Will Medicare Cover My Parkinson’s Disease?

Just shy of one million people in the U.S. are living with Parkinson’s disease – and ten times that amount are living with the disease worldwide. An estimated 60,000 Americans are diagnosed with Parkinson’s each year.ⁱ

If you are among these numbers, you may be wondering how you can use your Medicare benefits to manage your Parkinson’s. Let’s break down the various parts of Medicare to see how you can do this.

What you’ll learn:

• Original Medicare and Parkinson’s Care
• Living With More Than One Chronic Condition?
• Medicare Advantage and Parkinson’s Care
• Prescription Coverage for Parkinson’s Through Part D
• Medicare Supplement Insurance and Parkinson’s Care
• What are the Risk Factors for Parkinson’s?

Original Medicare and Parkinson’s Care

Part A

Part A (hospital care) covers hospital visits and skilled nursing facilities. Coverage for Parkinson’s often includes:

• Inpatient surgeries or medical treatment, including Duopa infusion therapy and Deep Brain Stimulation
• Limited-stay skilled nursing facility care
• Home healthcare, which can include occupational, physical, and speech therapy
• Inpatient psychiatric services
• Hospice services

You’ll have to pay a deductible ($1,556 in 2022) as well as other potential out-of-pocket costs. To see how Part A applies to your individual situation, call a licensed Ensurem agent at the number on this page.

Part B

Part B (medical care) addresses preventative and medically necessary services stemming from Parkinson’s. These outpatient offerings include:

• Visits to doctors and other providers
• Diagnostic tests and imaging
• Lab tests
• Outpatient procedures
• CT scans
• Injectable medications
• Wheelchairs, canes, and other durable medical equipment
• Limited home healthcare
• Physical, speech, and occupational therapy
• Blood transfusions and associated components
• Cassettes used with a Duopa pump, an essential part of carbidopa-levodopa therapy

You’ll be responsible for your annual deductible ($233 in 2022) plus other potential out-of-pocket costs.

Living with More than One Chronic Condition?

You may qualify for Chronic Care Management under Part B if you’re living with Parkinson’s and one or more other chronic conditions, like heart disease or diabetes.

If you’re living with multiple chronic conditions, you may qualify for medicare part B chronic care management. Chronic care management services include around the clock access, a care plan crafted just for you, 20 minutes of related services per month, and regular check-ins with your doctor. These services are covered when provided by physician assistants, nurse specialists, midwives, or nurse practitioners. Please note that you might also qualify for a medicare advantage special needs plan, offering these services and more.

Part B Chronic Care Management services include:

• Around-the-clock provider access
• At least 20 minutes of related services monthly
• An individually crafted care plan
• Regular check-ins with your doctor or provider

Providers who can bill for this include:

• Physician assistants
• Nurse specialists
• Midwives
• Nurse practitioners

Those who cannot bill for Chronic Care Management include:

• Dentists
• Podiatrists
• Psychologists
• Limited-license doctors

Medicare Advantage and Parkinson’s Care

Also known as Part C, Medicare Advantage offers everything provided by Parts A and B, but also may offer extended benefits such as dental, vision and medications. These privately sold plans have networks with doctors and other providers, and you may incur a fee by going out of network. It’s best to check that your preferred physicians are covered by a particular Advantage plan before making the purchase.

Medicare Advantage also provides Chronic Condition Special Needs Plans (C-SNP), which are tailored to those living with specific diseases such as neurological disorders like Parkinson’s.ⁱⁱ 

All Special Needs Plans are required to provide prescription drug coverage. Some plans allow you to go out of network to visit a particular provider, while others mandate that you stay within network. You’ll typically be required to choose a primary care doctor or have a care coordinator. While specialist visits usually mean getting a referral, services such as yearly screening mammograms and in-network pap test and pelvic exam do not require these.

With a special needs plan, you’ll need a primary care doctor and in most cases, you’ll need a referral to see a specialist, but all plans cover prescription drugs, and depending on your plan, you can see any health care provider.

These plans offer benefits and services not found in other types of Medicare Advantage Plans. One of the most notable benefits of a C-SNP is the use of care coordinators. These care coordinators help you stay on track with your care. For example, a care coordinator can help schedule appointments, get the right prescription drugs and monitor other health-related activities.

Prescription Coverage for Parkinson’s through Part D

Part D (prescription drug coverage) is an add-on to Original Medicare, which itself does not provide prescription drug coverage. Part D typically covers most common Parkinson’s medications, including:

• Levodopa and carbidopa (Duopa, Rytary, Sinemet)
• Mirapex (Pramipexole)
• Safinamide (Xadago)
• Amantadine (Gocovri)

However, before choosing a Part D plan, check the formulary to make sure your specific medications are covered.

Medicare Supplement Coverage and Parkinson’s Care

Medicare Supplement Insurance plans can help bridge the gap between Original Medicare and your medical costs. Also known as Medigap, these plans can address the following:

• Lengthier hospitalizations and room and board in skilled nursing facilities
• Physician charges that exceed Medicare-allowed costs for certain procedures
• Coverage outside the United States and Canada

According to the Parkinson’s Foundationⁱⁱⁱ, elements of a good Medigap policy include:

• Hospitalization coverage for up to a year or more beyond what Original Medicare allows
• Coverage outside the U.S. and Canada
• Eighty percent or more coverage for out-of-pocket doctor or surgeon charges

For a full description of the standard medigap plans and their benefits, please call an Ensurem licensed insurance agent at: 8 4 4. 8 4 7. 3 8 0 0.

There are 10 different standard Medigap plans named after letters of the alphabet. Listed in order of popularity, Medigap Plan G, Plan N and Plan A are commonly found to cover the services list above.

Remember that under federal law, you have six months from the time you start with Medicare to get guaranteed Medigap acceptance. Make sure you sign up in a timely manner in order to take advantage of this, or you may be subjected to medical underwriting when applying for a policy.

What is Parkinson’s?

According to the Mayo Clinic^iv, Parkinson’s disease is a progressive disorder of the nervous system that affects movement. It involves a portion of the brain known as the substantia nigra, which produces most dopamine in your body. When these cells begin to die off quickly, Parkinson’s may be the cause. Symptoms can be gradual but continue to worsen over time. Parkinson’s cannot be cured, but is manageable through medication and, in some cases, surgery designed to regulate the brain.

While symptoms vary with the individual person, they often include:

• Muscle rigidity that limits range of motion
• Tremors in a limb, often the fingers or hand
• Posture and balance issues
• Slowed movement, also known as bradykinesia
• Changes in speech that sometimes manifest in slurring, hesitation, or an increase or decrease in speed
• Changes in handwriting that can make it difficult to write or make your handwriting appear small
• Loss of ability to make unconscious movements such as blinking or smiling

What are the Risk Factors?

Johns Hopkins Medicine finds that between 10% and 20% of Parkinson’s cases have a genetic link, leaving the rest stemming from unknown causes.^v However, there is a set of risk factors including:

• Advancing age – the average person experiences onset around 60 years old
• Gender – men are more likely to develop Parkinson’s
• Environmental causes – chemical exposure and work with heavy metals, solvents, and detergents, though this is not a primary cause
• Trauma to the head – boxers such as Muhammed Ali, who have experienced blows to the head, have developed Parkinson’s

Those who have a genetic link are several times more likely to develop the disease than those without that hereditary factor.

Conclusion

While the research on Parkinson’s is still evolving, there are medical interventions that can help you successfully manage the disease. Finding a Medicare solution that covers such treatments and works with your lifestyle can make living with Parkinson’s more manageable.

If you’re struggling to find a Medicare plan that you’re confident will help you manage your Parkinson’s we can help.  Give us a call at the number on this page to speak with a licensed agent specializing in Medicare health and supplemental plans in your area.

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