Danielle Kunkle, who writes for a company called Boomer Benefits, contributed the following article, which explains the intricacies of how Medicare covers (and in some cases doesn’t cover) your Parkinson’s symptoms and treatments:
According to the Parkinson’s Foundation, close to one million Americans will be diagnosed with Parkinson’s disease (PD) by next year. Out of that one million, only around four percent are diagnosed before their 50th birthday.
These statistics prove that Parkinson’s is a disease that affects the senior population more than any other. This means that most Parkinson’s patients look to Medicare to help cover their diagnosis, treatment, and management. Fortunately, Medicare offers adequate coverage for these things.
How Medicare Covers PD Diagnosis and Treatment
Because there isn’t an actual test to diagnose Parkinson’s, your doctor, usually a neurologist, will determine what motor symptoms you have. Your doctor will also consider your family history as well as perform other general diagnostic tests.
Doctor visits and diagnostic testing are both covered under Medicare Part B. Medicare Part B covers outpatient services like these and things like lab work, surgery, and preventive care.
If your neurologist confirms that you have Parkinson’s, then they will discuss treatment options with you. However, it’s important to note that there is currently no cure for Parkinson’s, just treatments that can help you manage the disease.
Many Parkinson’s patients require physical and/or occupational therapy to maintain their motor skills. These forms of therapy are also covered under Part B if they are considered medically necessary.
Treatment: Prescription
There are three popular forms of treatment for PD, two of which are surgical options. The non-surgical option is treatment by medication. The most popular drug for treating Parkinson’s is Levodopa. This is a dopaminergic prescription that replaces and/or mimics dopamine neurons.
Since this is a retail prescription, Medicare Part D will be the part in charge of coverage. Most PD patients require medication to treat their symptoms. Fortunately, most Medicare Part D plans cover this prescription and ones like it.
Treatment: Surgery
Both surgical treatment options require the implantation of a device to help you manage your disease. The surgeries are Deep Brain Stimulation (DBS) and Duopa therapy. Like we mentioned above, Medicare Part B covers your medically necessary outpatient surgeries. Medicare Part A will cover your inpatient stay if you require one.
Here’s a little information about each surgery. DBS helps to reduce the occurrence of Parkinson’s symptoms. The surgeon places a pacemaker into your chest area that is connected to a wire that is attached to the area of your brain that controls your movement. The wire sends pulses to the brain to try and stabilize your brain cell movement.
The Duopa therapy surgery is the implantation of a device that is meant to deliver a gel version of Levodopa mixed with Carbidopa to the body. This surgery is only recommended to patients that saw improvement on the medication.
In addition to Part B covering the actual surgeries, Part B also covers durable medical equipment (DME). The devices that are implanted during these surgeries are considered DME. The gel version of Levodopa that is used with the device is considered a Part B medication since it is administered via a pump. Therefore, it wouldn’t be covered under Part D.
Cost-Sharing with Medicare Part A
Each part of Medicare has some form of cost-sharing with their covered services. These cost-sharing expenses usually include a deductible, copays, and coinsurance. If you require any Part A services such as an inpatient stay at the hospital or a skilled nursing facility, you will first have to meet a deductible before Part A will pay.
The deductible for Part A is 2019 is $1,364, and that’s per benefit period. Parkinson’s patients who receive one of the surgeries mentioned above usually don’t need hospital stays surpassing 60 days. However, if you do require a stay in the hospital for longer than 60 days, you will have a daily copay. The daily copay starts at $341 and bumps up to $682 on day 91. Your benefit period closes 60 days after you leave the hospital.
If your doctor feels you need to recover at a skilled nursing facility, your first 20 days will be covered under your Part A deductible. Days 21 through 100 will have a daily copay of $170.50.
Medicare Part B Cost-Sharing
Just like Part A, you must first meet a deductible before Medicare will pay anything. The annual Part B deductible in 2019 is $185. Once you have met your deductible, Medicare Part B will cover 80% of your costs for things like surgery, DME, doctor visits, and diagnostic testing. You will be in charge of covering the other 20%.
It’s important to mention that there is no maximum out-of-pocket with Medicare Part B. This means you could pay thousands of dollars in one year depending on the services you receive. Fortunately, Medicare has plans to help lower these out-of-pocket expenses. We will talk about those further down.
Medicare Part D Costs
What you’ll pay for your retail prescriptions will depend on the plan that you have. Each Part D plan has different copays and deductibles set for their beneficiaries. However, carriers must set their annual deductibles to $415 or below; the deductible can’t exceed $415.
As far as what you pay for each prescription, that will depend on your plan’s pre-set copays. Each plan sets copays for each tier of medication. Tier 1 is usually the least expensive and Tier 5 the most expensive, covering specialty drugs.
Medicare Plans That Help with Costs
There are two Medicare plans that can help with out-of-pocket expenses. Medigap and Medicare Advantage plans are add-on plans that lower out-of-pocket costs, provide extra benefits, and more. If you are a Parkinson’s patient, you can benefit greatly from one of these plans since you may have multiple doctor visits and medical services each year. You should consider one of these optional plans to help limit your out-of-pocket expenses for managing Parkinson’s. Be sure to enroll in one type of coverage or the other as soon as Medicare becomes your primary coverage.
