Multiple sclerosis (MS) can be a costly disease to treat. Prescription drugs, disease-modifying therapies, and other treatments can cost thousands of dollars every month. Public and private health insurance and assistance programs for prescription drugs can help to cover the costs of treating MS.
The most expensive part of MS treatment is prescription disease-modifying therapies. Most disease-modifying therapies for MS are classified as specialty drugs, which are drugs prescribed for chronic and complex conditions. They usually have a high monthly cost and are not stocked at the majority of retail pharmacies.
While drugs make up a majority of the cost of treating MS, people with the condition may undergo other treatments, including:
Furthermore, people may experience other health conditions and comorbidities alongside MS, like hypertension (high blood pressure) and hyperlipidemia (high levels of fat particles in the blood). These, too, can add to the cost burden. As drugs help to increase the life expectancy for people with MS, they may also increase the cost of treating the condition.
A study conducted in 2007 found that among 2,000 people with MS, most of them had some form of health insurance. However, many of the health insurance plans paid little or nothing toward the cost of medications and they limited access to different specialists, hospitals, and providers.
Costs for your MS treatment will be much more affordable if you have some form of public or private health insurance, including the following:
Below is a summary of these health insurance plans, eligibility requirements, and their benefits.
Watch medical bill advocate Susan Null discuss how people with chronic conditions can cut medical expenses.
Medicare is the federally sponsored health insurance program in the United States that covers adults age 65 and older and those with disabilities. Medicare has four parts: A, B, C, and D.
Part A covers:
Medicare Part B covers:
Medicare Part C is an alternative to Original Medicare and includes private Medicare Advantage plans that you can choose to enroll in. Part D provides limited prescription drug coverage.
If you’re over 65 and receive benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically be enrolled in Parts A and B when you turn 65. Similarly, if you are under 65, have a disability, and have received Social Security disability benefits or RRB benefits for at least 24 months, you will automatically be enrolled in Parts A and B. Medicare will send you a “Welcome to Medicare” packet and a red, white, and blue Medicare card three months before your 65th birthday. If you’re over 65 but do not get benefits from Social Security or RRB, you will need to sign up with Medicare to get Medicare Parts A and B at the Social Security website.
If you are diagnosed with MS, you will likely want to enroll in a prescription drug coverage plan through Medicare Part D. You can shop for and compare drug plans through the Medicare Plan Finder. Once you have selected a drug plan, you may enroll through the Medicare site or the plan’s website. In selecting a Medicare Part D drug plan, you will want to check the plan’s formulary, or list of covered drugs, to make sure that your prescription drugs are included.
Read more about Medicare for MS.
Medicaid is a state-operated health insurance program for people of low income, families, children, pregnant women, the elderly, and people with disabilities. Programs vary by state, so benefits and out-of-pocket costs vary by the state program. Most Medicaid programs cover services including:
You may enroll in Medicaid at any time of the year through your state’s Medicaid website or phone number. To learn more about enrolling in Medicaid in your state, navigate to your state’s Medicaid website. Check if you qualify for Medicaid by filling out a health insurance application on HealthCare.gov, the U.S. federal health insurance website. If you or a member of your household is determined to qualify for Medicaid, you will be contacted by your state agency to continue the enrollment process.
Read more about Medicaid for MS.
If you are a U.S. veteran living with MS, the Department of Veterans Affairs (VA) will provide you health care services for your entire lifetime, starting from the time of diagnosis. VA health care benefits cover a range of services and medical treatments to treat and slow the progression of MS. VA health care covers:
If your MS is determined to be connected to your military service, the VA offers additional benefits to aid in living with and treating your condition.
Read more about resources for veterans with MS.
Individual insurance plans are for people who are either:
Therapies, treatments, and medications for MS may be covered differently under different individual insurance plans. Most plans cover:
Before selecting a plan, make sure it covers your physicians and necessary services and drugs.
Read more about individual health insurance for MS.
Job-based health insurance — also known as employer-based insurance or group coverage — includes various health insurance plans offered by employers or unions to their employees as an employment benefit. If you work at least 30 hours per week at a company with more than 50 employees, it is likely that your employer will offer you some form of health insurance coverage. Companies with fewer employees may also offer benefits. If you have MS and don’t have a job, job-based health insurance may still be available to you through your spouse or parent (usually up to age 26).
There are several types of job-based health insurance plans, which vary in costs and services covered. Make sure to review your options carefully and discuss any questions with your company’s human resources department when selecting an insurance plan.
Read more about job-based health insurance for MS.
There are various other public and private programs that offer some type of financial support for MS treatments and prescription drugs, whether you have insurance or not. Some of these resources include:
MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 168,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.
Do you have MS and health insurance? Do you have tips for covering treatment costs? Share your experience in the comments below, or start a conversation by posting on your Activities page.