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Medicare

To ensure Medicare is able to provide quality, comprehensive healthcare for older Americans and people with disabilities, , including many living with MS.

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What We Are Trying to Accomplish

To ensure Medicare is able to provide quality, comprehensive healthcare for older Americans and people with disabilities, , including many living with MS.

Why It’s Important

Who is eligible for Medicare:
  • Social Security retirement recipients over 65 years old
  • Individuals who have received Social Security disability benefits for >24 months
  • Individuals who receive Railroad Retirement Benefits
  • Individuals who have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS or "Lou Gerhig's Disease")
Medicare and Medicaid can sometimes be confused with each other. Medicaid is a joint federal and state healthcare program for low-income people that is run at the state level. Medicare is a federal entitlement program for which an individual's income and assets are not considerations in determining eligibility.

People living with MS can qualify for Medicare coverage before age 65 if the Social Security Administration determines they are permanently disabled and they have received Social Security Disability Insurance benefits for more than 24 months.

People with MS are also eligible for Medicare when they reach age 65 if they receive Social Security or Railroad Retirement benefits. Individuals who retire early and choose to initiate Social Security retirement benefits at age 62 must still wait until they are 65 to receive Medicare.

Happening at the National Level

  1. In 2016, the Beneficiary Enrollment Notification and Eligibility Simplification Act was introduced to modernize the process of enrolling in Medicare Part B with basic education and a notice to all those nearing Medicare eligibility. If enacted, lifetime penalties for late enrollment, gaps in coverage and lack of access to care would decrease.
  2. Many beneficiaries with MS have benefitted from successful advocacy efforts to grant ‘exceptions’ for people who need more rehabilitation treatment than the current limits now provide. In February 2017, a proposal to update Medicare’s rehabilitation benefits was introduced with bi-partisan support.   
  3. Medicare payment reforms have the goal of rewarding greater quality and value of care in place of traditional payment approaches that reward greater volume of care. Careful study and evaluation is needed to help determine the best ways to make these goals meaningful for people with MS and their care providers.  We cautiously support new models of payment and service delivery in the Medicare program, encouraging careful monitoring of  possible unintended consequences for people with complex, chronic illness or disabling conditions like MS.
  4. People with MS can be negatively impacted when Medicare denies or limits coverage of rehabilitation due to lack of awareness about the importance of rehabilitation therapy in  improving and maintaining function  so people with MS can live, work, and play safely and independently in their homes and communities.  
    • The Society and other plaintiffs settled a class action in 2013 against Medicare’s erroneous claims that coverage of rehab services was not available for beneficiaries “no longer improving”.  In 2016, we returned to court after continued reports of coverage denials, once again based on the misperception that treatment was not covered unless “improvement” was possible and, once again, the court agreed.  
    • On February 2nd, 2017, the US District Court ruled in the plaintiffs’ favor, ordering Medicare to adopt our recommended strategy for  educating  providers and the public  to correct misperceptions about Medicare coverage for certain therapies.
  5. Among the Society’s “Make MS Medications Accessible” recommendations are calls for an annual cap on Medicare beneficiaries’ out-of-pocket costs for Part D covered medications, and allowing Medicare officials to negotiate prices for medications.

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