Best Health Insurance for People With Multiple Sclerosis

Multiple sclerosis (MS) is a disease that blocks messages sent from the brain to the body. It can cause symptoms such as difficulty with movement, vision, and thinking. MS is a chronic, debilitating illness, so those with the disease need to find health insurance coverage regardless of income.

This article covers the types of insurance available for people with MS, financial assistance for MS patients, and what to consider when choosing a health insurance plan if you have MS.

Health Insurance Options for Multiple Sclerosis

Adults and children with pre-existing conditions or disabilities cannot be denied insurance coverage.If you can't afford private insurance, your state might have Medicaid plans available. For others, private health insurance can help with covering MS treatment costs.

Medicaid

Medicaid is a low-income health insurance program funded by both states and the federal government. Some people qualify for Medicaid after becoming too disabled to work, which can happen to those with severe MS symptoms. Some Medicaid benefits are required by federal law, while some are optional and depend on the state.

Federal Medicaid requirements include:

• Screening and diagnoses
• Disease treatment
• Inpatient and outpatient care
• Home healthcare
• Physician services

States can decide whether or not to cover the following:

• Prescriptions
• Physical therapy
• Occupational therapy (therapy to help people with daily activities)
• Some diagnostic and clinic services

Some states have not adopted the Medicaid expansion that is part of the Affordable Care Act. This expansion allows people to become qualified for Medicaid with income alone (below 138% of the poverty level). For the states that did not adopt this expansion, disability, household size, and other factors are considered before approving Medicaid services.

Private Insurance

If you don't have health insurance through an employer, your spouse's employer, or your parents (if you're under the age of 26), you may need to look into private insurance. HealthCare.gov, also known as the Health Insurance Marketplace, is a great place to begin your search. Insurance company websites and searches can also help.

When shopping in the Health Insurance Marketplace, it's important to consider whether you qualify for a subsidy based on your income. This can provide some relief for more expensive plans, which might save you in the long run when it comes to out-of-pocket costs like prescriptions, which tend to make up a large chunk of MS treatment expenses.

Other Financial Assistance for Multiple Sclerosis

There are several nonprofit funds available to help people afford MS treatment, including:

• The Assistance Fund's MS Copay Assistance Program, which helps cover diagnosis and treatment
• Good Days, a nonprofit that helps with insurance premiums, copays, travel expenses, and diagnoses
• The Multiple Sclerosis Foundation grants for wellness assistance, living expenses, and more
• The Multiple Sclerosis Association of America's assistance services
• NeedyMeds, whose main focus is helping with prescription drug costs, also links patients to scholarships, grants, and patient networks
• The Patient Access Network Foundation provides MS medication assistance for people at or below 500% of the national poverty level
• Patient Advocate Foundation provides financial aid and case management services
  

Choosing an Insurance Plan: Things to Consider

Some things to look for in a health insurance plan if you have MS include the following:

Service Coverage

Service coverage is the kind of services an insurance plan will cover. There are services all healthcare plans in the U.S. must cover, including:

• Inpatient, outpatient, and hospital care
• ER visits
• Prescription drugs
• Occupational therapy (helps people with daily tasks, such as bathing or cooking)
• Health screenings
• Chronic disease treatments

It can be important for MS patients shopping for healthcare plans to consider additional costs like:

• Lab testing copays, such as those for MRIs
• Specialist visits, such as physical therapy sessions
• Speech therapy
• Cognitive rehabilitation therapy (for managing thinking problems)
• Mobility aids, such as canes or wheelchairs
• Hospitalizations
• Future surgeries
  

In-Network Doctors and Specialists

Checking if certain doctors, specialists, therapists, and hospitals are in an insurance network is an important part of choosing a health insurance plan for those with MS.

Also, it's important to check if a referral is needed to see a specialist or provider and how the referral process works.

Drug Formulary

Drug formularies are lists of medications that a health plan covers. This can be found on the Health Insurance Marketplace website for individual plans.

Medication is often the most expensive part of treating MS. For those with MS who are shopping for health insurance; it's important to consider the following:

• The level of drug that you're taking (generic versus brand name)
• Whether there is a separate prescription copay
• The prescription deductible (the amount you'll have to pay before coverage kicks in)
• The prescription out-of-pocket maximums (the most you have to pay on your own)
• Procedures for when a medication is not on your plan
• How infusion medications (medications administered via an IV needle) are labeled (as a prescription or as a medical service) and how this affects costs
• Whether there are "step therapy" requirements (less effective medications that patients must try before infusion medications)

Out-of-Pocket Costs

Out-of-pocket costs can include premiums, copays, and anything your insurance won't cover. Higher-tier plans, such as silver or gold-level plans, will have lower out-of-pocket costs and higher premiums.

Other out-of-pocket costs MS patients can consider include transportation expenses, supplements, traveling for care, special vehicles, food, and daily care.

Summary

People with MS can develop issues with balance, thinking and planning, walking, muscle fatigue, vision, and other parts of daily life. Because MS is a lifelong disease that can get worse over time, it's important for those who have the disease to pick the right health insurance plan. If cost is an issue, Medicaid plans and nonprofit organizations can help.

Private plans can be purchased through the Health Insurance Marketplace (HealthCare.gov) or a private insurance company's website. For those who do not find complete coverage via their health insurance plans, nonprofit organizations can help with funding diagnosis, treatment, travel, living expenses, and other parts of MS care.

A Word From Verywell 

Though paying for multiple sclerosis treatment can seem daunting, there is help available. Whether it's through Medicaid, federal subsidies that cover health insurance costs, or nonprofit networks, you can get the treatment you need covered. The key is advocating for your care, and considering the cost of MS, it's never a bad idea to ask a provider or organization how it can help.

Navigating healthcare is a demanding task, but with a bit of help, the support system and healthcare you're looking for could provide the care you deserve.