Multiple sclerosis (MS) is a condition that affects the nervous system through an auto-immune response that deteriorates the protective covering of the nerves. This leads to pain, mobility concerns, vision problems, balance issues and difficulty in muscle coordination. MS affects different people in different ways, allowing some with the condition to live a life relatively free from symptoms while causing others to deal with severe and debilitating problems that grow worse over time.
Treatment Options for MS
Currently, treatment for MS takes a multi-faceted approach. Medications are often used to suppress the body’s immune response. This eases symptoms and potentially slows the progression of MS as medications address the root cause of MS as an auto-immune disorder.
Physical therapy is also used to treat and rehabilitate MS patients who experience more severe symptoms. Through physical therapy, MS patients are able to re-train the brain and its connection to the nervous system in order to bypass damaged nerves that reduce physical function and coordination.
Another treatment option is to undergo plasma exchange procedures. During a plasma exchange, a patient’s blood is separated from the plasma cells it contains, and the plasma cells are coated in a particular protein. The plasma is then mixed back in with a donor’s blood and re-introduced into the patient. This approach cleans the blood of harmful proteins that could lead to auto-immune attacks that cause the painful symptoms of MS.
Currently, there are no simple surgical solutions to MS as no corrective action can alleviate symptoms without removing nerve tissue altogether. To take this approach would leave the patient with numbness and lack of mobility, and these outcomes are not desirable and will not stop the auto-immune response in the end, meaning more attacks are likely to occur. There are, however, surgical procedures that are being used to address the neurological symptoms of MS, including deep brain stimulation and medication pump injections.
Does Medicare Cover Treatment for MS?
Because MS can affect people of any age, seniors are susceptible to the symptoms of the disease. Thankfully, Medicare does provide coverage for a number of treatment options for MS. Medicare part A, sometimes known as hospital insurance, is the part of Medicare coverage that offers assistance in paying for care while admitted to a hospital. This part of Medicare would cover services if you are hospitalized due to MS directly or due to injuries resulting in an injury related to an MS-associated accident.
Medicare Part B is the outpatient portion of the program, and it offers coverage for things like visits to a doctor for MS treatment, rehabilitation services and testing and screening. Medicare Part B does require a premium to remain active as a part of your Medicare benefits plan, and you will likely need to meet a deductible amount before benefits apply for the year. If you undergo a surgical procedure for MS, Medicare Part B would likely cover the procedure, but Medicare benefits under Part A would be used for time spent recovering in a hospital or skilled nursing facility.
If you are prescribed medications for MS that can be purchased from a retail pharmacy, then Medicare Part D will apply toward payment. Note that Medicare does not cover supplements or over-the-counter medications. Although Medicare’s prescription drug coverage provides benefits for a wide range of medications, you will need to consult with your plan’s formulary to ensure that your prescribed medications are covered. If your MS medication is not covered, you may be able to apply for an exception.
Medicare recipients are also encouraged to work closely with their healthcare provider to monitor new or worsening conditions so that plans can be made for Medicare coverage. Some Medicare recipients will experience few changes in symptoms over the course of their lives, but others may experience flares in symptoms that require different treatment approaches at different times. Working with your doctor and Medicare plan manager now can help you to avoid surprises in the future if symptoms change and treatment methods need to be adjusted.