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How Does Medicare Handle ALS Coverage

Medicare Bob
Medicare General Info
Americans with ALS, or Lou Gehrig’s disease, can receive Medicare coverage soon after diagnosis.
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Amyotrophic Lateral Sclerosis (ALS) — also known as Lou Gehrig’s disease — is a progressive disease without a cure that affects as many as 30,000 Americans. On average, about 1,000 people with ALS apply for Social Security Disability Insurance each year.

Prior to July 23, 2020, people with ALS had a five-month SSDI waiting period and could not get Medicare coverage until their SSDI benefits began. However, the ALS Disability Insurance Access Act eliminated that requirement, allowing those with ALS to get Medicare benefits the month their SSDI benefits kick in — no matter the person’s age.

How Do ALS Patients Enroll in Medicare?

People with ALS are eligible for automatic enrollment into Medicare Part A and Part B the first month they receive SSDI or a railroad disability annuity check.

According to the Social Security Administration, the processing time for SSDI claims when it comes to ALS has been significantly cut down in recent years. In one example, using an online application, the SSA says it was able to process an ALS SSDI claim in just two days.

It’s important to note that the SSA has an expedited process for people with terminal illnesses, calling this type of case a “TERI.” When applying for SSDI, the SSA recommends notifying them that the individual has SLD and a “TERI” case procedure is appropriate.

Will Automatic Enrollment in Medicare Cover Everything?

Upon automatic enrollment into Original Medicare, someone with ALS can also select a Medicare Part D plan to help with prescription drug costs. A Medigap plan may be able to help with additional costs, but availability may vary from state to state and depending on the patient’s age.

If you’re in a state where Medigap plans aren’t available to you because you’re under 65 or for any other reason, a Medicare Advantage plan may be another option.

For more information, call Senior Healthcare Direct at 1-833-463-3262, TTY 711, to speak with a licensed agent. 

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.

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