Medicare and Home Health Information

Medicare Parts A, B, C, and D: What Each Covers for ALS Care and Treatment

Original Medicare Part A: Hospital Care, Skilled Nursing, and Home Health Services

Medicare Part A covers four core service areas for people living with ALS: inpatient hospital care, skilled nursing facility (SNF) care, hospice care, and some home health services. [6] To qualify for SNF coverage, you must first complete a qualifying inpatient hospital stay of at least three consecutive days -- time spent under hospital observation status does not count toward that requirement. [7] Home health services under Part A apply when you need part-time or intermittent skilled nursing or therapy and meet the homebound standard, meaning leaving home requires considerable effort. [8] Those services can include nursing visits, [physical therapy](https://alsunited.org/blog/upper-body-physical-therapy-exercises-for-als), occupational therapy, and speech-language pathology -- each of which directly addresses the care needs that emerge as ALS progresses. [8]

Original Medicare Part B: Doctor Visits, Therapies, and Durable Medical Equipment

Medicare Part B covers the outpatient services most people with ALS use regularly: visits to [neurologists and other specialists](https://alsunited.org/blog/what-type-of-doctor-treats-als), physical therapy, occupational therapy, speech-language pathology, and durable medical equipment such as wheelchairs and communication devices.[9] Part B also pays for diagnostic tests ordered as medically necessary -- including blood work and nerve conduction studies -- and for certain medications that cannot be self-administered at home, which applies to some ALS treatments given by infusion or injection.[9] In 2025, Part B carries a $257 annual deductible; after that, Medicare pays 80% of approved costs and you pay the remaining 20% coinsurance.[10] That cost-sharing structure applies across the full range of outpatient services, so knowing it early supports financial planning as care needs change.

Medicare Advantage (Part C) and Part D: Prescription Drug Coverage and Managed Care Options

Medicare Advantage (Part C) plans are sold by private insurers and must cover everything Original Medicare covers, but most also add benefits like hearing, vision, and fitness -- coverage areas that become relevant as ALS progresses. [9] The trade-off is network restrictions: unlike Original Medicare, Advantage plans typically require you to use in-network providers, which can limit access to ALS specialists at larger medical centers. [11] Part D, also run through private insurers, covers take-home prescription drugs and organizes them by cost tiers -- [ALS medications](https://alsunited.org/blog/mechanisms-of-als-medications) like riluzole may fall on different tiers depending on your plan, directly affecting monthly out-of-pocket costs. [9] Because Part D formularies change every year, reviewing your plan each fall during open enrollment is the most reliable way to avoid coverage gaps or unexpected cost increases on drugs you depend on. [12]

Home Health Care Coverage Under Medicare: What's Included and What You'll Pay

How Medicare Covers In-Home Nursing, Physical Therapy, and Occupational Therapy

Medicare covers home health services -- including skilled nursing visits, physical therapy, occupational therapy, and speech-language pathology -- when two conditions are met: you need part-time or intermittent skilled care, and you qualify as homebound, meaning leaving your home requires considerable effort. [8] Most home health care is covered under Part B, though Part A may also apply following a qualifying three-day hospital or skilled nursing facility stay. [13] Medicare does not cover 24-hour care, meal delivery, or custodial tasks like laundry and meal preparation unless those services are performed as part of a skilled nursing or therapy visit. [13] For people tracking [ALS progression](https://alsunited.org/blog/the-7-stages-of-als-how-they-could-be-broken-down), understanding which services qualify helps set realistic expectations for what in-home care Medicare will actually fund. [8]

Durable Medical Equipment and Mobility Aids Covered at Home

Medicare Part B covers durable medical equipment (DME) for home use -- including hospital beds, wheelchairs, walkers, and home oxygen equipment -- when a doctor prescribes it as medically necessary. [14] For people with ALS, DME needs typically expand as the disease progresses, from walkers in earlier stages to power wheelchairs, ceiling lifts, and suction machines later on. [14] Medicare covers only the most basic version of equipment that meets your medical need; any upgrades or special features are billed to you as the cost difference. [15] Power wheelchairs and scooters require prior authorization before Medicare will approve them, so starting that process early reduces delays when mobility declines. [14]

Out-of-Pocket Costs: Copayments, Deductibles, and Coverage Gaps for Home Services

Covered home health services -- skilled nursing visits, therapy, and home health aide care -- carry no copay or coinsurance under Original Medicare; you pay $0 for those visits. [16] Durable medical equipment is different: after the annual Part B deductible, you owe 20% of the Medicare-approved amount for items like wheelchairs and hospital beds. [16] The most significant cost gap in Original Medicare is the absence of an annual spending cap -- expenses can accumulate without limit, while Medicare Advantage plans cap in-network out-of-pocket costs at $9,250 in 2026. [17] Medicare also excludes custodial care, 24-hour home care, and homemaker services entirely, so families needing that level of support must arrange private pay, long-term care insurance, or Medicaid separately. [18]

Navigating Medicare Enrollment and Finding Support Through ALS United

Step-by-Step Medicare Enrollment Process for People with ALS

For people with ALS, the Medicare enrollment process begins automatically -- Social Security enrolls you in both Part A and Part B as soon as SSDI is approved, with no separate application needed. [1] The active decisions come after that: understand what each Medicare part covers, compare Original Medicare to Medicare Advantage, then decide whether to add Part D drug coverage or a Medigap supplement policy. [1] Your Medicare card and welcome package arrive three months before your coverage start date; if it doesn't appear on schedule, contacting your local Social Security office directly resolves most enrollment issues. [2]

Financial Assistance Programs That Help Pay Medicare Costs and Copayments

Four state-administered Medicare Savings Programs can reduce what people with limited incomes pay for Medicare coverage. The most comprehensive -- the Qualified Medicare Beneficiary (QMB) Program -- covers Part A and Part B premiums, deductibles, coinsurance, and copayments. [19] The Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programs each cover Part B premiums, while the Qualified Disabled and Working Individual (QDWI) program covers Part A premiums only. [19] Because some states set higher income and resource limits than federal minimums, applying even when you're unsure whether you qualify is worth doing -- contact your state Medicaid office to start. [19] Medigap policies can also cover Medicare coinsurance and deductibles not addressed by these programs, adding another layer of cost protection. [20]

How ALS United's Clinic Finder and Support Services Connect You to Medicare-Covered Care

Finding Medicare-accepting ALS specialists is easier when you combine the right tools. Medicare.gov's Care Compare tool lets you search by specialty and location to confirm which providers accept Medicare, complete with profiles and driving directions. [21] Your state's SHIP program provides free, unbiased, one-on-one Medicare counseling to help you compare plan options and understand your out-of-pocket costs before committing to a provider. [22] Our Clinic Finder connects you directly to ALS-specialized clinics that accept Medicare, and our [care services team](https://alsunited.org/blog/our-care-services) helps coordinate equipment access, benefits navigation, and financial assistance -- support that bridges the gap between what Medicare covers and what ALS care actually requires. [21]