Health insurance and access to healthcare are important for everyone, especially people with chronic diseases like Parkinson’s disease (PD). It is important not only to understand health care coverage for immediate health care needs, but also long-term health care needs. Health insurance protects the patient and family from being solely responsible for the cost of medical services, which can be considerable for a person with PD. Someone diagnosed with PD will face multiple doctor’s visits, prescription drugs, allied health services, and potentially surgery. A person with PD should have health insurance that includes hospitalization, major medical coverage, and generous prescription coverage. People with PD should also consider coverage for in-home nursing care or care in a nursing facility.
Group/employer insurance
Group or employer insurance are those plans provided by the patient’s or family member of patient’s employer. An advantage is that it is typically offered to an employee without asking about pre-existing conditions like PD. It is important to pay attention to whether the policy covers in-home or nursing care. If the patient has to leave work coverage options may be continued through COBRA for 18 months (and possibly up to 36 months). If the PD patient has children covered by his/her group policy, they should be moved to the policy of a healthy partner, if possible.
If your COBRA option runs out, the Health Insurance Portability and Accountability Act (HIPAA) guarantees your right to continue coverage on a state-approved private insurance. HIPAA prohibits exclusions for pre-existing conditions.
It is important not to have a gap in insurance coverage. It is also important to keep the group insurance as long as you can.
Private health insurance
Private health insurance typically requires evidence of good health to qualify, and pre-existing conditions such as PD may be excluded. This is a good option for a PD patient who obtained insurance by receiving a diagnosis of PD and for caregivers and children of the patient. Long-term care insurance is also an option, which includes nursing home care.
Affordable Care Act
The Patient Protection and Affordable Care Act (ACA) passed in 2010 and changed the rules for eligibility for health insurance plans. ACA provides employers incentives to provide insurance to employees and penalizes large employers who do not offer health insurance to employees. ACA also ensures that individuals with pre-existing conditions, like Parkinson’s, cannot be denied coverage. Although the ACA is in flux, coverage of pre-existing conditions will likely remain. However, it is possible that expenses will increase for people with pre-existing conditions if they have a lapse of coverage.
Government insurance programs
Insurance programs provided by the government include Medicare, Medicaid, and Veteran’s benefits, among others. Each program has its own eligibility requirements.3
Medicare
Medicare provides coverage for healthcare services for people who are 65 and older, as well as younger people with disabilities.2 If you are under 65 and want Medicare because of disability you must undergo a two-year waiting period before being eligible to enroll. This covers doctor’s appointments, lab tests, physical therapy, etc. Medicare only covers care in a nursing facility on a short-term basis. Medicare also provides a Prescription Drug Plan. However, if you reach an annual spending limit, you are responsible for paying for the drugs for the remainder of the year. There is a Medicare supplement sold by private companies that can help pay for costs that Medicare does not cover.
Medicaid
Medicaid is a service that is provided by the federal and state governments to provide coverage for health care services to people with low-income, as well as people with disabilities and those who receive federally assisted income maintenance payments, such as Supplemental Security Income.2,4 Depending on the state’s program, Medicaid may cover assisted-living facilities. Since types of coverage varies across states, it is important for the patient to do extensive research to determine what is available. Visit https://www.medicaid.gov/ for more information.
Social Security Disability Insurance
To qualify, you must have worked and paid into Social Security for a requisite number of quarters, must demonstrate you cannot be employed because of your medical disability, and must show your disability will last for more than 12 months. The social security administration has a Listing of Impairments for Parkinson’s and other diseases, which includes significant rigidity, slowed movement, or tremor in two extremities. To read more about SSDI visit https: www.ssa.gov/planners/disability/.
Veteran’s benefits
Veteran's benefits cover current and retired military personnel. The Department of Veterans Affairs (VA) has six specialized centers across the country known as the Parkinson’s Disease Research, Education and Clinical Centers (PADRECCs). PADRECCs serve veterans with PD with clinical care, education, and research. These PADRECCS serve a large geographic area and are staffed by movement disorders specialists. In addition, the VA finalized a regulation that provides some veterans with moderate to severe traumatic brain injury who also have parkinsonism, including PD, to receive additional disability pay. There is also a disability compensation process for veterans who have PD and who were exposed to Agent Orange or other herbicides during military service.2 For more information, check out the Department of Veterans Affairs (VA) website.