Medicare covers medications, surgery, and specific ultrasound treatments that doctors commonly use to treat those with Parkinson’s disease.
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 parts A and B benefits 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 piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
According to the Davis Phinney Foundation for Parkinson’s, Medicare covers drugs and surgical treatment for the 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.
Part A coverage for Parkinson’s disease may include:
- inpatient surgeries or treatment
- home healthcare, including physical, occupational therapy, and speech therapy
- skilled nursing facility care for a limited time
There are out-of-pocket costs for Part A, such as a $1,408 deductible for each benefit period.
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 $352 copayment applies for days 61–90 in each benefit period.
Parkinson’s disease coverage for Part B covers outpatient services, such as:
- lab tests and other diagnostic tests, such as 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:
- $144.60 Part B monthly premium
- $198 annual deductible
- 20% coinsurance
Private insurance companies offer Part C, also known as 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.
Costs of Medicare Advantage plans include deductibles, copayments, coinsurance, and monthly premiums, all of which vary.
The plans put an annual cap on expenses, beyond which a person pays nothing for eligible care.
Medicare Part D
Private insurance companies also offer Medicare Part D, known as a prescription drug plan (PDP).
A person with original Medicare may purchase a PDP, which includes coverage of common medications a doctor prescribes for Parkinson’s disease.
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.
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.
Costs of Medigap plans include the monthly premiums.
Doctors diagnose approximately 60,000 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.
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.
Symptoms usually appear slowly and become worse over time.
The primary symptoms 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 motor, or movement symptoms, a person may have non-motor symptoms, such as:
Parkinson’s disease currently has no known cure, but an array of medications produce substantial relief from symptoms.
Other treatments include two kinds of surgery, a specific ultrasound procedure, and lifestyle practices, such as getting more exercise and rest.
Current drug treatment options 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.
- 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.
If medication does not reduce the symptoms for a person with Parkinson’s disease, the following treatments could be effective.
Deep brain stimulation
In deep brain stimulation, a doctor implants electrodes into the brain that connect to a small device.
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.
Duopa therapy is an infusion of levodopa and carbidopa.
Before a person can begin treatment, a doctor makes a small hole surgically in the stomach wall to insert a tube into 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.
Unilateral focused ultrasound thalamotomy
Unilateral focused ultrasound thalamotomy is a non-surgical procedure that helps some individuals with tremor-dominant Parkinson’s disease.
This procedure involves focusing beams of ultrasonic energy to 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 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.
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 800-473-4636, or contact them by email at firstname.lastname@example.org.
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.