Does Medicare Cover Multiple Sclerosis Treatment?

Multiple sclerosis is a chronic condition that affects more than approximately one million people in the United States and 2.8 million people worldwide. While there's currently no cure for MS, it's possible to manage it through a combination of medical care and lifestyle adaptations.

In this article, you'll find out more about MS and how much of your treatment Medicare covers, with specific information regarding the different parts of Medicare and the various MS treatments. 

When Does Medicare Cover Multiple Sclerosis Treatment?

Medicare is likely to offer coverage for at least some of your medical treatment for multiple sclerosis. Costs vary depending on your specific plan and the recommendations your physician makes.

Coverage includes medically necessary medications, doctor visits, hospital treatments and stays, occupational therapy, physical therapy and medical equipment.

Which Parts of Medicare Cover Multiple Sclerosis Treatments?

MS doesn't affect any two people in an identical way, so effects depend on which parts of the body are affected and which type of MS you have. As such, Medicare coverage can vary significantly from person to person, depending on their unique requirements.

Original Medicare

Medicare Part A and Medicare Part B make up Original Medicare. The former covers care in inpatient facilities, such as hospitals, skilled nursing facilities and hospices. It also includes any therapy and medication you receive during your stay.

Part B helps you pay for professional services in an outpatient facility, such as a doctor's office. This includes any treatments and medications recommended by a medical professional. 

Medicare Advantage

Also called Medicare Part C, Medicare Advantage is an alternative to Medicare that you buy from a private provider who has a contract with Medicare. When using this type of plan, you need to make sure any health care providers and pharmacies you use are in-network with your provider.

Medicare Advantage replaces Original Medicare and covers the same costs, with some additional benefits that might include:

• Eye care
• Ear care
• Occupational physical or speech therapy
• Dental care
• Wellness programs

Medicare Part D

Part D is a supplement to other Medicare plans that helps you cover the cost of medications. All plans come with a unique formulary, so be sure to check with your provider about the most common medications used to treat MS. 

Medigap

A Medigap plan can help you pay for out-of-pocket costs such as coinsurance, copays and deductibles. You pay a premium for any of the 10 Medigap plans, but someone with a chronic condition such as MS might save money long-term with this type of plan.  

Medically Necessary MS Treatments

If treatment is deemed medically necessary, many of the costs are covered by Medicare. Below is an explanation of some of the treatments, services and medications you might need 

MS Health Care Services

The exact services you require depends on the type of MS you have and how serious the condition is. Many of the health care services for people with MS are covered by Medicare Part B. Although, if you receive care in an inpatient setting, it'll be Part A that covers the costs.

Depending on your situation, you might need:

• Physical therapy
• Occupational therapy
• Speech therapy
• Mental health counseling 

Medications for MS

There are a number of FDA-approved medications to help slow the progression of the disease, treat relapses and manage the symptoms. If you're given these medications in the hospital, Part A should cover the costs. However, the medications you take on a daily basis at home require Medicare Advantage or Medicare Part D for coverage.

Drug therapies for MS might include:

• Methylprednisolone (Solu-Medrol)
• Prednisone (Deltasone)
• ACTH (H.P. Acthar Gel)
• Glatiramer acetate (Copaxone)
• Fingolimod (Gilenya)
• Ocrelizumab (Ocrevus)
• Interferon beta-1a (Avonex, Rebif, Plegridy)
• Interferon beta-1b (Betaseron, Extavia)

Medical Equipment 

Medicare Part B covers the durable medical equipment your treatment provider recommends for the home. This might include:

• Mobility scooters
• Walkers
• Wheelchairs
• Mattresses or cushions to relieve pressure
• Aids for going to the bathroom
• Canes

Costs 

Specific costs vary depending on your individual situation, but the following table gives you an idea of the basic costs of the different Medicare parts.  

What Is MS?

Multiple sclerosis is a condition in which the immune system mistakenly attacks the central nervous system. It affects the spinal cord and brain, leading to potential difficulties with vision, sensation, balance and movement of the arms and legs. It can be progressive and cause serious disability.

Most of the symptoms of MS are treatable, and those with the disease can live a full, happy life. It's most commonly diagnosed when a person is in their 20s or 30s and is more likely to affect women than men. 

Types of Multiple Sclerosis 

There are four main types of MS.

• Clinically isolated syndrome: This alone isn't enough for a diagnosis of MS, but many people who have CIS go on to develop it. CIS is a severe neurological episode that might be characterized by problems with vision, muscle weakness, loss of bladder or bowel control or muscle stiffness.
  
  
• Relapse-remitting MS: The majority of people with MS have this expression of the disease. It's characterized by relapse cycles where the symptoms get worse and then go into remission without progression. 
  
  
• Secondary progressive MS: This diagnosis is given if an RRMS flare up doesn't go into remission. Short periods of relapse and occasional stabilization might be present.
  
  
• Primary progressive MS: PPMS involves a consistent progression of symptoms without remission or relapse.

MS Symptoms

Some of the most common symptoms associated with multiple sclerosis include:

• Fatigue
• Issues with vision, such as blurred vision
• Difficulty walking
• Trouble with bladder control
• Tingling or numbness, particularly in the extremities
• Muscle spasms and muscle stiffness
• Decreased libido
• Difficulty planning, learning and thinking
• Issues with balance and coordination