How Does Medicare Cover Essential Tremor?

By Danielle Kunkle Roberts,
Co-Founder of Boomer Benefits

Danielle Kunkle Roberts, Boomer BenefitsEssential Tremor (ET) is a neurological disorder that causes involuntary shaking and trembling. It affects approximately 10 million people in America, according to the International Essential Tremor Foundation, which makes ET the most common neurological disorder.

While not dangerous, the condition can make simple tasks such as tying your shoes or drinking a glass of water more difficult. ET can also get worse over time.

Because ET is more common for people in later adulthood, it’s good to know how Medicare will cover treatment of this disorder.

Medicare Part A Hospital Benefits

Original Medicare is made up of Part A hospital benefits and Part B outpatient benefits. 

Part A covers inpatient hospital stays, skilled nursing facility care, and hospice care. This is the part that would pay most of the expenses related to a hospital stay for deep brain simulation (DBS), which is a common surgery that provides relief from tremors and stiffness.

Medicare Part B Hospital Benefits

Medicare Part B covers outpatient care. This includes doctor visits, preventive care, lab-work, diagnostic testing, emergency care, outpatient surgeries, physical therapy, durable medical equipment and much more.

Part B will pay for your patient visits to your specialist, the necessary neurological exams and lab-work and any outpatient procedures used to control ET symptoms.

One outpatient procedure to treat ET is focused ultrasound treatment. This minimally invasive treatment was approved by the FDA in 2016. It is the first brain disorder treatment to be allowed reimbursement by Medicare Part B. The procedure destroys a small amount of brain tissue that contains nerve cells which are responsible for the tremors.

Earlier this summer Medicare announced benefit coverage for patients in 16 states. Additional states were added this past fall. There are numerous medical centers that now treat patients with Essential Tremor using MR-guided focused ultrasound. A Medicare physician must document why the procedure is reasonable and necessary.

Medicare Part D Drug Benefits

Outpatient medications to help treat your ET symptoms will fall under Part D. Medicare Part D is optional coverage  beneficiaries can purchase to reduce the cost of their prescriptions.

These plans are sold by private insurance companies and each plan has its own premiums, copays, coinsurance, pharmacy network, and drug formulary. Beneficiaries can use Medicare’s Plan Finder Tool to search for the right plan.

Your Medicare Cost-Sharing

As with all insurance coverage, Medicare covers a share and the member also pays a share of their coverage. This is called your cost-sharing and it usually comes in the form of deductibles, copays, and coinsurance.

Part A has a $1364 deductible in 2019, and Part B has a smaller $185 annual deductible. Medicare Part B covers 80% of your outpatient procedures. You are responsible for paying the other 20%.

Fortunately, you can supplement your coverage with either a Medicare supplement policy or a Medicare Advantage plan. Both types of coverage will help to limit your out-of-pocket expenses on the gaps in Medicare.

Beneficiaries can call 1-800-MEDICARE or consult a Medicare insurance broker for guidance in choosing a plan that fits their needs and benefits.

                                                               * * * *

Danielle K. Roberts is a Medicare insurance expert and co-founder at Boomer Benefits, a licensed agency that helps beneficiaries with their supplemental coverage options.

‘It’s the Man Who Overcomes Adversity that is the True Champion’

Each semester, the International Essential Tremor Foundation presents four scholarships to students with essential tremor. The scholarships represent hope for the future, and provide support to these students during a pivotal time in their lives. As part of the scholarship application process, each applicant is asked to write an essay that answers the question, “How has essential tremor affected my life?” The following essay is from one of our fall 2018 scholarship recipients

 

By Robbie Holder,
Georgia Southern University

I do not remember a time when my hands did not noticeably shake. I was diagnosed with essential tremor (ET) at the early age of 14. While I recognized I was not the only Photo of Robert Holder, 2018 IETF Scholarship Recipientperson to experience tremors of this nature, I didn’t know anyone my age who suffered from this diagnosis. My other has ET and her grandmother suffered from it also; therefore, my diagnosis was not unexpected as it is hereditary. Since that time, I have reconciled myself with the knowledge that ET isn’t curable. I have found peace with the fact that I will always have a tremor. I haven’t used my diagnosis as an excuse to quit or avoid certain tasks, but have chosen to work harder in order to succeed.

My mother is an artist and while having a tremor makes it more difficult for her to create art, she doesn’t let it stop her from doing what she loves. She has to intensely focus on the task at hand. She has made adjustments to accomplish daily tasks. Like my mom, I have learned to adapt in order to accomplish tasks that come easily for others. I struggle to open packets, eat with a spoon, peel shrimp, button clothes, brush my teeth and insert contacts. Utilizing both hands, I have more control of my movements.

ET can be frustrating. I enjoy physical activities and working with my hands. My goal is to study exercise science. ET makes it difficult, but not impossible.

I have not let my ET keep me from doing the things I love. I truly believe it’s the little things in life that make a difference. With my family’s help, I built a Little Pantry for my community during my senior year in high school and I continue to run it today. Those in need obtain food and household items without the stigma of being seen as helpless. Others in the community can make a difference by restocking the pantry. Despite the frustrations I encountered during the pantry’s construction, I feel that I have made a difference and continue to do so.

I have been inspired by a quote that I keep close to my heart. It’s by Jock Ewing:

“Any man can win when things go his way. It’s the man who overcomes adversity that is the true champion.”

The challenges I face daily have made an impact on my life. I have to worker harder, persevere when faced with challenges, and find strength from within. These challenges have made me resilient, hard-working and confident. I choose to be strong. I have a desire to succeed and a strong work ethic. I finish what I start and I don’t let anything get in my way.

I know ET will always be a part of my life, but it will not define who I am. I choose to overcome.

*********

Interested in supporting students with ET during their educational journey? Make a donation to the ET scholarship fund online.