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How Does Medicare 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, 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 help pay for them?

These types of tests should fall under diagnostics tests, which Original Medicare (and therefore Medicare Advantage plans) can cover.

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-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 Medicare Advantage plans, but most of the time, you can count on Medicare 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, Medicare 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.

Medicare generally covers 80 percent of therapies, and you owe 20 percent of the approved amount for outpatient treatment.

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. Medicare 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 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.

These prescription drugs can be broken up into three main categories — managing symptoms, slowing the condition’s progression, and treating relapses.

Both Part D and MA plans are approved by Medicare 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.

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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 helps cover your tests and treatments. Your focus can be on more important things than finances.