Here's where we stand as noted by Kirk Hall in his blog shakypawsgrampa.com.
(Of course who knows what will happen over the next two years with the idiot in the Whitehouse backed by gutless members of the POT).
Parkinson’s disease (PD) is a challenging condition as it is, but the fact that it is irreversible means that ongoing care management is an important factor. People who suffer from Parkinson’s disease have to work with their doctor to help manage their debilitating condition. Therefore, understanding how Medicare covers the procedures, medications, and supplies that are used to manage PD is a must.
Coverage for Parkinson’s Disease Procedures
The two most commonly used procedures for managing Parkinson’s disease are deep brain stimulation and Duopa therapy. Both of these procedures require surgery, one being more invasive than the other.
Medicare Part A covers your inpatient hospital stay if it is needed and also covers surgeries that are performed during an inpatient stay. However, outpatient surgeries will be covered by Medicare Part B which also pays for other outpatient items like doctor’s visits, lab testing, and diagnostic imaging.
What You’ll Pay
Usually, Medicare beneficiaries qualify for premium-free Part A. However, there is a deductible you must meet before Part A will cover anything. Your Part A deductible for 2019 is $1,364. This will cover your stay for 60 consecutive days in the hospital. If for any reason you require a longer stay for your surgery, you will begin to pay a daily copay after day 60.
Many PD patients will require skilled nursing care after surgery. The $1,364 deductible you pay will also cover your first 20 days in a skilled nursing facility (SNF).
In 2019, most people will pay $135.50 each month for Medicare Part B. After you have met your annual deductible of $185, Part B will cover 80% of costs for your surgery, while you’ll be in charge of the other 20%.
Coverage for Parkinson’s Disease Medications
Almost every PD patient requires a dopaminergic medication. A dopaminergic medication is a drug that either helps to replace the dopamine neurons that are lost or to mimic them. Many doctors prescribe Levodopa because it has proven to be most effective.
The part of Medicare that covers this medication depends on how the medicine is administered. If you take the oral pill of Levodopa, the coverage will fall under Medicare Part D. However, if you went through surgery for Duopa therapy and you receive your Levodopa by way of a pump, Medicare Part B will cover the medication. Part B covers any injectable medications that are administered in a doctor’s office setting too.
What You’ll Pay
If Medicare Part D is covering your medication, you will have to check your drug plan’s formulary to make sure Levodopa is included. Luckily, most Part D drug plans cover Levodopa. The amount you pay for your medication depends on what tier your plan has classified Levodopa in and how much they charge for that tier.
If your medication is covered through Part B usually, the Part B deductible will apply and then Medicare covers 80% of the cost. If you have already met your deductible earlier in the year, though, you won’t have to pay it again until the next calendar year.
Coverage for Parkinson’s Disease Supplies
The pump you have installed for Duopa therapy is considered durable medical equipment (DME). Medicare Part B covers your medically necessary DME. Other durable medical equipment a PD patient may need are wheelchairs, walkers, and canes.
What You’ll Pay
In order for Medicare Part B to cover any of your DME, you must get it from a Medicare-approved supplier. If you do that, you will pay 20% of the cost while Medicare pays 80%. Be sure to ask your supplier if they accept Medicare assignment. If they don’t, they could charge you up to 15% extra for the supply.
Medigap Plans That Can Help
As you can see, there is a lot of potential for out-of-pocket spending when trying to manage your Parkinson’s disease. Fortunately, Medicare has provided standardized plan options to help lower your out-of-pocket spending.
One type of plan you can enroll in is a Medigap plan. Medigap plans help either to eliminate or lower your deductibles, coinsurance, and copays. For instance, Medigap Plan G would cover all Part A and Part B expenses mentioned above expect your Part B deductible.
The other type of plan you can enroll in to help cut costs is a Medicare Advantage plan. Medicare Advantage plans set their own prices and therefore are all different. However, they all must cover at least what Medicare covers. These plans have networks so you’ll want to make sure your important doctors are in the network before you enroll in one.
Unsure of what type of plan you need to help pay for your Parkinson’s treatment? Contact a Medicare expert and find out today.
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