Parkinson’s Disease and Medicare Coverage

April is Parkinson’s Awareness Month, a time dedicated to raise awareness about this neurological condition, advocate for research, and support those living with Parkinson’s disease.

At Senior Financial Group, we understand the challenges faced by Parkinson’s patients and their families. During Parkinson’s Awareness Month, and throughout the year, we’re committed to helping seniors navigate the complexities of Medicare coverage for Parkinson’s treatment.

What is Parkinson’s Disease?

Parkinson’s disease (PD) is a neurodegenerative disorder that affects nearly 1 million Americans. According to the Parkinson’s Foundation, Parkinson’s is the second-most common neurodegenerative disease after Alzheimer’s disease. It primarily affects the part of the brain responsible for producing dopamine, a crucial chemical messenger that helps control movement. As dopamine levels decline in individuals with Parkinson’s, brain cells deteriorate, leading to the characteristic motor symptoms like tremors, rigidity, and slowness of movement.

While there’s currently no cure, there are a variety of treatment options available that can help manage symptoms and improve quality of life. If you’re a senior diagnosed with Parkinson’s and have Medicare, understanding your coverage options is crucial.

Medicare Coverage for Parkinson’s Disease

The good news is that Medicare covers many of the essential treatments for Parkinson’s disease. Here’s a breakdown of some key areas:

Medications: Part D (Medicare prescription drug coverage) helps pay for medications used to manage Parkinson’s symptoms, such as levodopa, carbidopa/levodopa, and dopamine agonists. However, you’ll typically need to enroll in a separate Part D plan offered by private insurance companies to receive prescription drug coverage.
Doctor Visits: Part B covers doctor visits with neurologists and other specialists who manage Parkinson’s disease. Copays may apply, depending on your specific Medicare plan.
Hospitalization: If your Parkinson’s symptoms require hospitalization, Part A will likely cover your inpatient stay. This includes necessary medications, tests, and therapies received during your stay.
Outpatient Therapy: Part B can cover outpatient therapies like physical therapy, occupational therapy, and speech therapy. These therapies can help manage movement problems, improve daily living skills, and address communication challenges. There may be copay requirements and annual limits on therapy services.
Durable Medical Equipment (DME): Part B may cover DME prescribed by your doctor to help manage Parkinson’s symptoms. This could include walkers, canes, wheelchairs, and specialized devices for tremors or speech difficulties. Medicare typically requires a doctor’s written order and proof of medical necessity for DME coverage.

Parkinson’s Medications

Fortunately, Medicare offers coverage for several medication classes that can help manage the symptoms of Parkinson’s disease:

Dopamine Replacement Therapy: These medications, such as levodopa and carbidopa/levodopa, directly replace or mimic the effects of dopamine in the brain, improving motor function.
COMT Inhibitors: These medications, like entacapone (Comtan), work by enhancing the effects of levodopa, allowing it to last longer and work more effectively throughout the day.
Medications for Non-Motor Symptoms: Parkinson’s can also cause non-motor symptoms like anxiety, depression, and psychosis. Medicare may cover medications to address these challenges, including:
- Selective Serotonin Reuptake Inhibitors (SSRIs): These antidepressants, such as fluoxetine (Prozac) or sertraline (Zoloft), can help manage anxiety and depression.
- Atypical Antipsychotics: Medications like quetiapine (Seroquel) or pimavanserin (Nuplazid) may be prescribed to treat psychosis in some Parkinson’s patients.

Parkinson’s Treatments and Therapies

Parkinson’s disease management focuses on controlling symptoms. Here’s an overview of services and therapies covered by Medicare for Parkinson’s:

Advanced Treatment Options (May Require Prior Authorization):

Focused Ultrasound: This non-invasive treatment uses focused sound waves to target specific areas deep within the brain. It’s sometimes used in the early stages of Parkinson’s to improve motor function and reduce tremors.
Deep Brain Stimulation (DBS): For patients who no longer find adequate symptom relief from medications, doctors may recommend DBS. This surgical procedure involves implanting electrodes in the brain, connected to a neurostimulator device placed in the chest. The device sends electrical pulses to regulate brain activity and improve movement control.

Medication Delivery Methods (May Require Prior Authorization):

Duopa Pump: If oral carbidopa/levodopa medication becomes less effective, a Duopa pump may be an option. This pump delivers a gel form of the medication directly into the small intestine through a tube inserted during a minor surgical procedure.

Rehabilitation Therapies:

Skilled Nursing Care (SNC): Medicare covers a limited period (typically 21 days) of part-time skilled nursing care at home. A doctor’s certification of medical necessity is needed to extend this duration.
Nursing Facility Care: For short-term stays following hospitalization with a qualifying condition, Medicare covers the first 20 days of care in a skilled nursing facility (SNF). A daily copay applies for days 21 through 100, and beneficiaries are responsible for the full cost after 100 days.
Physical and Occupational Therapy: Medicare covers physical and occupational therapy services to help manage movement limitations and improve daily living activities. Physical therapy focuses on larger muscle groups, while occupational therapy addresses coordination and fine motor skills.
Speech Therapy: Difficulty speaking and swallowing are common challenges in Parkinson’s. Speech therapy can help patients maintain communication skills by addressing weakened muscles in the throat, mouth, and tongue.

Mental Health Services:

Depression Screenings and Counseling: Recognizing and addressing depression, anxiety, and other non-motor symptoms of Parkinson’s is crucial. Medicare covers depression screenings and mental health counseling services to help manage these conditions.

Important Note:

Prior authorization from Medicare may be required for certain advanced treatment options or medication delivery methods. It’s best to discuss these procedures with your doctor to determine if they are covered by your specific Medicare plan.

What Medicare May Not Cover

While Medicare covers many essential Parkinson’s treatments, it’s important to be aware of potential gaps in coverage:

Long-Term Care: Medicare generally doesn’t cover long-term care services in a nursing home or assisted living facility unless you need skilled nursing care following a hospitalization.
Experimental Treatments: Medicare typically doesn’t cover treatments considered experimental or investigational.
Complementary and Alternative Medicine (CAM): While some CAM therapies may be helpful for managing Parkinson’s symptoms, Medicare generally doesn’t cover these costs.

Additional Considerations

Medicare Supplement Insurance (Medigap): Medigap plans can help cover some out-of-pocket costs associated with Original Medicare (Parts A & B), such as copayments, deductibles, and coinsurance.
Medicare Advantage Plans: These private insurance plans offered by Medicare-approved companies provide all the benefits of Original Medicare (Parts A & B) and often include additional benefits like prescription drug coverage (Part D) and vision/dental coverage.
Financial Assistance: There are programs available to help low-income beneficiaries with Medicare costs. These include Medicare Savings Programs (MSPs) and Extra Help for prescription drug coverage.

Remember: Don’t hesitate to reach out to your doctor or a Medicare specialist with any questions you may have about your Parkinson’s treatment and how your Medicare plan applies.