Health care costs for people with chronic illnesses like lupus can skyrocket due to the expense of certain types of treatment. Medicare benefits can help cover some of those costs depending on the type of treatment and its medical necessity.
Understanding Lupus
Lupus, an autoimmune disease, causes pain and inflammation throughout a person’s body, but typically impacts a person’s skin, joints and organs like the kidneys and heart. There are four distinct types of lupus:
- Systemic lupus erythematosus (SLE). This type of lupus is the most common form and can be considered mild or severe.
- Cutaneous lupus erythematosus. The impact of this form of lupus is restricted to the skin and manifests as disk-shaped rashes for most people.
- Drug-induced lupus erythematosus. This mild and temporary type of lupus develops as a reaction to certain types of medications for some people; most symptoms associated with lupus are gone after six months once the medication is no longer taken.
- Neonatal lupus. Although not considered a true form of lupus, some babies may be born with temporary skin and liver problems if the mother has lupus.
Systemic lupus is difficult to diagnose and frustrating to treat because symptoms come and go. The diagnostic process for lupus can take time since some symptoms are also typical of other, often more common chronic illnesses.
Health Complications Associated with Lupus
The strain that long-term inflammation and poor immune function has on the rest of the body is significant. People with lupus are much more likely to experience a loss of kidney function, headaches and dizziness, vascular issues and respiratory problems.
Managing and treating other health conditions may be made more difficult for people with lupus, too. Lupus can be particularly problematic for women who are pregnant since it increases the risk of miscarriage or preeclampsia.
Common Types of Lupus Treatment
While there is no cure for lupus, there are direct and indirect treatments that either target the disease itself or help mitigate its symptoms. If you’ve been diagnosed with lupus, your treatment will be determined by the symptoms you’re experiencing and any relevant lab work that reveals points of concern.
Direct courses of treatment are prescription medications that work with different systems of the body. Some of these medications may treat inflammation or they may suppress the body’s immune response in order to control the systemic impact lupus has on the body.
Some of these medications may be approved for use for lupus itself or they may be prescribed for off-label use, which means they are not approved by the Food and Drug Administration for lupus treatment.
If lupus has damaged other organs in the body, then surgical procedures or treatments like dialysis may be required.
Medicare Coverage for Lupus Treatment
Most Medicare recipients who have been diagnosed with lupus can expect their Medicare benefits to work as they would with any other chronic illness. Part A covers costs associated with any qualifying inpatient hospital stays, minus any deductible or coinsurance owed on the part of the beneficiary. Part B handles outpatient visits and specialist services.
Recipients who need prescription medication to help manage their lupus will need a Part D prescription drug plan. They can either purchase a standalone plan or get coverage through a Medicare Advantage plan. The cost of copays and yearly limits for prescription medication coverage are determined by individual insurance carriers, so check formularies to make sure the medications you need are covered. It’s important to note that Medicare provides coverage for prescription medications that are prescribed only for their FDA-approved use. Off-label use may be not eligible for coverage through a Medicare plan.
Typically, SSDI recipients must wait 24 months after receiving their payments before they can enroll with Medicare. If lupus has led to End-Stage Renal Disease, that patient may be eligible for immediate Medicare coverage once they are approved for Social Security Disability insurance payments due to the ESRD diagnosis.
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