Does Medicare provide coverage for Parkinson’s disease?

Medicare covers medications, surgery, and specific ultrasound treatments that doctors commonly use to treat those with Parkinson’s disease.
Under Original Medicare, Part A covers inpatient surgeries, while Part B covers outpatient procedures, lab tests, and doctor visits.
A person with Original Medicare may buy a Part D plan for prescription drug coverage, which would include medications for the disease.
The alternative to Original Medicare is Medicare Advantage, which provides all of the benefits of parts A and B under one policy. Most generally include prescription drug coverage as well.
This article examines the Parkinson’s disease coverage of each part of Medicare. Then, it describes the disorder, as well as discusses treatment options and support resources.
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Coverage
Share on Pinterest
According to the Parkinson’s Foundation, Medicare coversdrugs and surgical treatmentfor the disease.
Medicare covers
In addition, Medicare covers a noninvasive surgical procedure called unilateral focused ultrasound thalamotomy, which could help those who have tremor-dominant Parkinson’s Disease.
covers
Parkinson’s Disease
Below, we look at the coverage details of each part of Medicare.
Original Medicare consists of Part A, hospitalization insurance, and Part B, medical insurance.
Original Medicare
Part A coverage for Parkinson’s disease may include:
Part A
may include
inpatient surgeries or treatment
home healthcare, including physical, occupational therapy, and speech therapy
occupational therapy
speech therapy
skilled nursing facility care for a limited time
There are out-of-pocket costs for Part A, such as a $1,632 deductible for each benefit period.
$1,632
A benefit period begins the day a person enters a hospital and ends on the 61st day of being at home.
There is a $0 copayment for the first 60 days that a person is in the hospital. A $408 copayment applies for days 61–90 in each benefit period.
Parkinson’s disease coverage for Part B covers outpatient services, such as:
Part B
such as
lab tests and other diagnostic tests, such as X-rays
X-rays
outpatient surgeries
doctor visits
medical equipment, such as wheelchairs and canes
injectable medications
some home healthcare
Part B out-of-pocket costs include:
include
$174.70 Part B monthly premium
$240 annual deductible
20% coinsurance
Private insurance companies offer Part C, also known as Medicare Advantage.
Part C
Medicare Advantage
These plans provide the same inpatient and outpatient coverage of parts A and B for Parkinson’s disease treatment.
Many plans also offer prescription drug coverage. A person with a Medicare Advantage plan usually has lower costs if they choose in-network doctors and hospitals.
lower costs
Costs of Medicare Advantage plans include deductibles, copayments, coinsurance, and monthly premiums, all of which vary.
Costs of Medicare Advantage
copayments
The plans put an annual cap on expenses, beyond which a person pays nothing for eligible care.
Private insurance companies also offer Medicare Part D, known as a prescription drug plan (PDP).
Medicare Part D
A person with Original Medicare may purchase a PDP, which includes coverage of common medications a doctor prescribes for Parkinson’s disease.
may purchase
Because medications are a primary treatment method, it is important for a person with the disease to have a PDP.
Part D costs include deductibles, copayments, coinsurance, and monthly premiums. These costs differ among plans.
An individual with Original Medicare may buy a Medigap plan, which is also known as Medicare supplement insurance.
Medigap
The plans vary in their coverage, but they help pay up to 100% of out-of-pocket costs associated with parts A and B, including those related to Parkinson’s disease.
up to 100%
Costs of Medigap plans include the monthly premiums.
include
What is Parkinson’s disease?
Doctors diagnose approximately 90,000 people in the United States with Parkinson’s disease every year, according to the Parkinson’s Foundation. The disease is a motor system disorder that causes uncontrollable movements.
90,000
It starts developing when cells die or become damaged in the part of the brain that makes dopamine, a chemical the body needs for smooth, purposeful movements.
dopamine
Symptoms usually appear slowly and become worse over time.
The primary symptoms include:
include
tremors that occur mainly when a person is at rest
limb rigidity and muscle stiffness
slowing of automatic movement that makes it hard to do simple, everyday tasks
balance problems that can increase the risk of falls
In addition to the movement symptoms, a person may have non-motor symptoms, such as:
constipation
constipation
sleep disorders
sleep disorders
depression
depression
a decline in the ability to think clearly
Parkinson’s disease treatment
Parkinson’s disease currently has no known cure, but an array of medications produce substantial relief from symptoms.
no known cure
Other treatments include two kinds of surgery, a noninvasive surgical procedure using ultrasound, and lifestyle practices, such as getting more exercise and rest.
Current drug treatment options include:
include
A combination of levodopa and carbidopa: Nerve cells use levodopa to produce dopamine in this common treatment, which refills the brain’s declining supply. Carbidopa prevents levodopa from converting to dopamine until it reaches the brain.
Anticholinergic drugs: Such drugs oppose the action of acetylcholine, a body chemical that causes muscles to contract. Due to this action, it can reduce tremors and muscle rigidity.
acetylcholine
can reduce
Pramipexole, ropinirole, and apomorphine: Acting like dopamine in the brain, these reduce symptoms because the nerve cells respond to them in the same way they respond to dopamine.
Amantadine: This antiviral drug seems to reduce symptoms.
This antiviral drug
If medication does not reduce a person with Parkinson’s disease symptoms, the following treatments could be effective.
In deep brain stimulation, a doctor implants electrodes into the brain that connect to a small device.
deep brain stimulation
The device sends electrical impulses to the brain, which stimulate it to block signals that lead to many of the motor symptoms.
Although the surgery reduces symptoms, it does not prevent Parkinson’s disease from advancing and some symptoms may slowly return.
reduces symptoms
Duopa therapy is an infusion of levodopa and carbidopa.
Duopa
Before a person can begin treatment, a doctor makes a small hole surgically in the stomach wall to insert a tube into the intestine.
the intestine
Afterward, a pump slowly and consistently sends Duopa through the tube into the intestine.
Doctors recommend this therapy for some people with advanced Parkinson’s disease.
recommend this therapy
Unilateral focused ultrasound thalamotomy is a noninvasive surgical procedure that helps some individuals with tremor-dominant Parkinson’s disease. However, these benefits may decrease over time.
helps some individuals
This procedure involves focusing beams of ultrasonic energy on parts of the brain that produce specific symptoms of the disorder.
However, not all individuals have what doctors would categorize as tremor-dominant Parkinson’s disease.
Parkinson’s disease resources
Parkinson’s disease is a serious disorder with debilitating effects.
A person who has received this diagnosis may contact the Parkinson’s Foundation for help in navigating all aspects of the disease.
Parkinson’s Foundation
The foundation provides a wealth of educational material on the latest research, along with an online community that offers emotional support.
To contact the foundation, a person can call 1-800-473-4636 or contact them by email at [email protected].
Summary
Parkinson’s disease is a progressive disorder that produces both motor and non-motor symptoms. Although there is currently no known cure, treatment can help dramatically.
Original Medicare, which consists of parts A and B, and Medicare Advantage cover treatment for the disease.
Parts A and B do not include prescription drug coverage. Because medication can make a big difference for those with Parkinson’s disease, a person with Original Medicare may wish to have a Part D prescription drug plan.
Most Medicare Advantage plans include prescription drug coverage.
Before a person buys a Medicare Advantage plan or Part D plan, they may like to compare the costs of available plans as these can vary considerably.