Medicare
Who Qualifies for Medicare
Enrolling in Medicare and Switching Plans
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Initial Enrollment Period
For Those Aged 65 and Older
When you first qualify for Medicare, you have a 7-month window to enroll in Original Medicare, a Medicare Advantage Plan and a prescription drug plan. The window starts 3 months before your effective month. If you don’t sign up during this time and don't have other coverage (for instance, through an employer), you may have to pay a late enrollment penalty.For SSDI Recipients
If you're on SSDI, you're automatically enrolled in Medicare Parts A and B after receiving SSDI benefits for 24 months. You will receive your Medicare card in the mail before coverage begins. If you don't want Part B, which comes with a monthly premium, you can choose to opt out. However, if you decline Part B and decide to enroll later, you may have to pay a late enrollment penalty.For prescription drug coverage, you can either sign up for a stand-alone Medicare Part D plan or choose a Medicare Advantage (Part C) plan that includes drug coverage.Annual Open Enrollment Period
From October 15 to December 7 each year, you can:- Join, drop or switch Medicare Advantage Plans (including drug coverage)
- Switch from Original Medicare to a Medicare Advantage Plan, or vice versa
- Join, drop or switch Medicare drug plans if you have Original Medicare
It’s important to review your plan during this period to ensure it meets your MS care needs. For help choosing the right Medicare plan, connect with an MS Navigator.
Medicare Coverage Options
MS Prescription Drug Coverage
infusion DMTs to treat MS. These are usually given by a doctor or at an infusion center. - There’s no extra cost to take part in the Medicare Prescription Payment Plan. You won’t be charged interest or fees, even if you’re late on a payment. You can leave the program anytime, but you’ll need to pay any remaining balance.
- It doesn’t reduce or lower your drug costs. To learn about programs that might lower your costs, visit Medicare’s “5 Ways To Get Help With Prescription Costs.”
- Your monthly bill may change if you get new prescriptions or refill existing ones since there will be fewer months left in the year to spread out the payments. If you want to know what a drug will cost, ask your plan or your pharmacist.
- This payment plan doesn’t cover Part B drugs, like the infusion DMTs to treat MS. These are usually given by a doctor or at an infusion center.
- There’s no extra cost to take part in the Medicare Prescription Payment Plan. You won’t be charged interest or fees, even if you’re late on a payment. You can leave the program anytime, but you’ll need to pay any remaining balance.
- It doesn’t reduce or lower your drug costs. To learn about programs that might lower your costs, visit Medicare’s “5 Ways To Get Help With Prescription Costs.”
- Your monthly bill may change if you get new prescriptions or refill existing ones since there will be fewer months left in the year to spread out the payments. If you want to know what a drug will cost, ask your plan or your pharmacist.
- Your yearly drug costs are low or stay the same each month
- You plan to sign up later in the year (after September)
- You prefer to keep paying for drugs the same way you do now
- You qualify for Extra Help from Medicare, a Medicare Savings Program, or get help paying for your drugs from other programs like:
- A State Pharmaceutical Assistance Program (SPAP)
- A coupon program
- Other health coverage
- For free health insurance counseling, visit shiphelp.org to find your local SHIP.
- Get personalized support with exploring your Medicare plan options for your MS by connecting with an MS Navigator.
- Your health or drug plan.
- Visit your plan’s website or call for more details.
- If you urgently need a prescription, call your plan to discuss your options.
- Medicare.
- Visit Medicare.gov to learn more about how this law affects you.
- State Health Insurance Assistance Program (SHIP).
- For free health insurance counseling, visit shiphelp.org to find your local SHIP.
- The National MS Society.
- Get personalized support with exploring your Medicare plan options for your MS by connecting with an MS Navigator.
Follow these steps to join this payment plan anytime during the year:
- Go to your health insurance plan’s website or call your plan. The phone number is on the back of your membership card.
- Visit Medicare’s Joining a Plan page to learn more and enroll.
- If you need help contacting your plan, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Other MS-Specific Needs
- Medicare Part B covers durable medical equipment (DME), such as wheelchairs, walkers, canes, and other assistive devices, as long as they are deemed medically necessary by a healthcare provider.
- Medicare Part A and Part B cover certain home health services for MS patients, such as:
- Skilled nursing care
- Physical therapy
- Home health aide services
- Medicare Part A covers inpatient hospital stays, including those related to MS. This includes costs for room, meals, general nursing and other hospital services.
- Medicare covers medically necessary physical, occupational and speech therapy to treat MS symptoms. These therapies are important for maintaining mobility and function when living with MS. Coverage for continued therapy may be subject to certain limits or requirements.
- Make sure your Medicare plan covers visits to neurologists or MS specialists, who are essential to your care.