No More Two-Year Wait for Medicare Benefits for ALS Patients

Harvard Pilgrim would like to remind the provider network of the recent legislation eliminating the 24-month waiting period for Medicare Part A benefit eligibility for individuals diagnosed with amyotrophic lateral sclerosis (ALS)/Lou Gehrig’s disease, and we ask that you please share this information with patients who may benefit from it to ensure that they’re aware of all their coverage options.

Typically, anyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. However, Public Law 106-554 amended section 226 of the Social Security Act to waive this waiting period for Medicare coverage for disabled individuals medically determined to have ALS. ALS patients can now access Part A benefits premium-free immediately upon SSDI eligibility, which means that they may be able to receive benefits such as home health care with no out-of-pocket cost in addition to their regular commercial Harvard Pilgrim insurance.

As a reminder, certain patients may also be eligible for premium-free Part A benefits if they receive regular dialysis treatments or have received a kidney transplant, have filed an application for Medicare, and meet the necessary conditions.

For more information about eligibility, enrollment periods, and determining when coverage begins, it may be helpful to refer your patients to this article from the Centers for Medicare and Medicaid Services (CMS).

Publication Information

Annmarie Dadoly,

Joseph O’Riordan,

Kristin Edmonston,
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