Health insurance will play a big role in covering your medical costs—including equipment. By learning how everything works and applying on time, you can save yourself thousands of dollars and unnecessary headaches.
The most important thing you need to know is that most people with ALS qualify for Medicare health coverage and Social Security Disability Insurance (SSDI)—regardless of age. Medicare will cover the bulk of your healthcare costs and SSDI will provide you with a monthly income. Private insurance and Medicaid can help fill in your gaps in healthcare coverage.
Navigating the insurance maze can be frustrating, challenging, and full of paperwork. But taking the time to understand it and follow through is well worth the effort.
The most important thing you need to know is that most people with ALS qualify for Medicare health coverage and Social Security Disability Insurance (SSDI)—regardless of age. Medicare will cover the bulk of your healthcare costs and SSDI will provide you with a monthly income. Private insurance and Medicaid can help fill in your gaps in healthcare coverage.
Navigating the insurance maze can be frustrating, challenging, and full of paperwork. But taking the time to understand it and follow through is well worth the effort.
SSDI and Medicare
Social Security Disability Insurance (SSDI) is a federal program that provides monthly income for people who become unable to work due to a disability. Medicare is a national health insurance program for seniors and some disabled people. If you qualify for SSDI, you automatically receive Medicare disability benefits, too.
Am I eligible?
YOU DO NOT HAVE TO BE 65 TO QUALIFY! Most people with ALS qualify for SSDI and Medicare. Once you have been diagnosed with ALS and have stopped working, you should qualify—regardless of age—as long as you have worked in the last ten years and paid standard Social Security taxes for at least ten years.
What does it cover?
SSDI will send you monthly checks to help compensate for your lack of income. The amount you receive will depend on how much you earned and paid into Social Security over the years.
Medicare will cover the majority of your medically necessary services and durable medical equipment, though you will still need to pay monthly premiums and cover the remaining gaps.
Medicare will cover the majority of your medically necessary services and durable medical equipment, though you will still need to pay monthly premiums and cover the remaining gaps.
What else?
- You only need to apply for SSDI. If you qualify, you will receive both SSDI and Medicare benefits. You do not need to apply separately for Medicare.
- There is a five-month waiting period between applying and receiving benefits. You cannot apply until you have stopped working due to ALS.
- If you have private long-term disability insurance, and then qualify for SSDI, your long-term disability policy benefits may be reduced based on the terms of your policy.
- Medicare is very helpful—and complicated. There are multiple options, so it is important to research and decide what is best for you.
- Medicare will not cover non-medical care at home or the costs of caregiving facilities.
Medicaid
Medicaid is a national program administered by states that provides health insurance to low-income adults and children.
Am I eligible?
The primary criteria for Medicaid eligibility is financial, including income and assets. Every state’s eligibility formula is different. Criteria for Medicaid’s long-term care coverage is different.
What does it cover?
If you have Medicare, Medicaid will help pay for the remaining 20% of your health care costs. If you qualify for Medicaid but not Medicare, Medicaid will be your primary insurance. Medicaid can also help cover long-term care.
What else?
- Every state offers a Medicaid program. All programs meet federal standards, but some states offer more generous benefits than others.
- Contact your state for details.
Private Insurance
Private companies sell a variety of health insurance plans to individuals and families.
Am I eligible?
Anyone who can afford a plan can purchase one. Since the passage of Obamacare, insurance companies can no longer reject people with pre-existing conditions or charge them more. However, monthly premiums continue to increase.
If Congress makes substantial changes to healthcare laws in the near future, there will likely be a transition period between the laws.
If Congress makes substantial changes to healthcare laws in the near future, there will likely be a transition period between the laws.
What does it cover?
There are a wide variety of plans. The more you pay in monthly premiums, the more comprehensive your coverage should be.
What else?
- Health care options and plans are in constant flux—and even more so since the passage of Obamacare and the 2016 election.
- The majority of nondisabled Americans under age 65 purchase private plans, either independently or at a discounted rate through their employer.
- Private insurance will not cover non-medical care in your home nor the costs of caregiving facilities.
For Additional Information
- ALS Association's Resource Guide for Understanding Insurance and Benefits
