Does Medicare cover the cost of multiple sclerosis drugs?

The cost of multiple sclerosis (MS) drugs and services is covered by various sections of original Medicare, Part D, and Part C, or Advantage, plans.
MS is a chronic condition that affects the central nervous system. Nearly 1 million people older than 18 have a diagnosis of MS in the United States. Globally, more than 2.3 million people have diagnosed MS.
1 million
In this article, we look at the symptoms of MS, then describe coverage provided by:
MS
original Medicare, or parts A and B
Part C, known as Medicare Advantage
Part D
Medigap plans
We also compare the costs.
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.
What is multiple sclerosis?
Share on Pinterest
MS targets the nervous system and may harm the optic nerves, spinal cord, and brain.
The disease slows or stops messages between the brain and other parts of the body. Symptoms vary, depending on the affected areas, and they change over time. MS symptoms may include:
symptoms
fatigue
numbness or tingling in the arms and legs
vision problems
weakness
depression
memory problems
poor balance and coordination
There are four types of the disease, including:
four types
clinically isolated syndrome, the first episode of MS
relapsing-remitting MS
secondary progressive MS
primary progressive MS
Doctors do not know what causes the disease, though it may be triggered by the immune system. MS affects more females than males, and doctors typically diagnose it in people aged 20–40 years old.
20–40
The disease does not tend to cause severe disability, and it is not known to cause paralysis. However, MS-related conditions or complications can shorten a person’s life by up to 7 years.
7 years
Though there is no cure for the disease, there are treatments, and receiving these early on can reduce the impact of MS in the long term.
Medicare coverage
The effects of MS depend on the areas of the body involved, and the symptoms can change over time. Therefore, the need for Medicare coverage can also change, involving different parts of Medicare at different times.
Medicare coverage
Original Medicare includes parts A and B.
Part A covers care in hospitals, hospices, and skilled nursing facilities, including the medications and therapies involved during these stays.
Part B covers many professional services and treatments that a person with MS might need, including medication provided in a doctor’s office.
Part B also covers medically necessary durable medical equipment that a person with MS might need in their home, such as:
cushions or mattresses that help relieve pressure
aids for using the toilet
canes
walkers
wheelchairs
mobility scooters
Also known as Part C, these plans are alternatives to original Medicare, and they provide the same coverage.
Some offer additional benefits, such as:
physical, occupational, or speech therapy
eye care
hearing care
dental care
wellness programs, such as gym memberships
One key difference is that Part C, or Advantage, plans are provided by private companies, and a person must use doctors, pharmacies, and providers within the plan’s network.
Part D plans are designed to cover prescribed medications, including many for MS. A person purchases one of these plans separately.
Each Part D plan has a list, called a formulary, of covered medications. These medications are grouped by price.
formulary
Medigap plans are designed to cover out-of-pocket costs, including deductibles, copays, and coinsurance.
Each of the 10 Medigap plans has a premium to pay. However, a person with MS may find that the additional coverage saves them money in the long term. This online tool can help a person find a plan that best suits their needs.
10 Medigap plans
online tool
Costs
Because a person with MS may require coverage from different parts of Medicare at different times, the costs can vary considerably.
The table below shows the basic costs of each Medicare part.
basic costs
A person can use this online tool to compare the costs of plans C and D.
online tool
Summary
Original Medicare, Medigap, Part D, and Part C — or Advantage — plans each cover various costs associated with MS care, including costs of medications.Because the symptoms of MS can change over time, a person may need coverage for visits to the doctor, in-hospital services, tests, therapies, and medications.