Insurance

Understanding Medicare can help you make informed decisions about your healthcare coverage. This AARP article gives an overview of the federal health insurance program. 

Medicare is available to:

• People 65 or older who are eligible for Social Security or Railroad Retirement benefits.
• People under age 65 who have received Social Security Disability Insurance (SSDI) or U.S. Railroad Retirement Board Disability (RRB) benefits for 24 months.
• People of all ages living with Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease), once SSDI or RRB benefits have been awarded.
• Those with end-stage renal disease (kidney failure), with coverage starting three months after beginning dialysis or retroactive to the first month of self-dialysis.

People living with Parkinson’s who are younger than 65 and can no longer work should apply for Social Security Disability Insurance benefits as soon as possible, because qualifying for Medicare requires receiving these benefits for 24 months. Gaps in medical insurance coverage can occur during the extended amount of time it can take to process a Social Security Disability Insurance application, especially if an appeal is involved. 

Avoid lifelong late enrollment penalties. It’s important to sign up for Medicare coverage during your initial enrollment period (typically beginning three months before you turn 65 and ending three months after the month you turn 65) unless you have coverage equal to Medicare through another source, such as your job or spouse. 

Estimate your Medicare eligibility and premium. 

Eligibility for both is guaranteed regardless of health, which means a person can't be turned down for pre-existing health conditions, such as Parkinson's.

• Part A (hospital insurance) is generally free. It helps cover hospital stays, limited skilled nursing facility care, in-home health care and hospice care.
• Part B (medical insurance) must be elected and paid for through Medicare. It helps cover doctors’ visits, outpatient care, lab services, home health care, medical supplies and preventive services, such as flu shots and mammograms.
  • After you meet the annual Part B deductible, Medicare generally pays 80% of the approved amount for covered services. You are responsible for the remaining 20% unless you have supplemental coverage.
  • If you do not sign up for Part B when you first become eligible, you can enroll during a General Enrollment Period, from January 1 through March 31 of each year. If you didn’t enroll because you or your spouse had group coverage through employment, you can enroll during a Special Enrollment Period. You may be assessed a late-enrollment penalty for failing to enroll in Part B when first eligible to do so.
• Original Medicare does not cover prescription drugs. If you choose this option, you will want to choose prescription drug (Part D) coverage. You might also consider supplemental Medigap coverage, which can help with out-of-pocket costs and give you greater choice in the healthcare providers you see.

These plans are offered by private insurance companies approved by Medicare. They include all Medicare Part A and B services and often offer extra benefits, such as prescription drug coverage and lower co-payments. However, Part C plans don’t always offer the flexibility of Original Medicare, which allows you to see any healthcare provider in the U.S. who accepts Medicare and rarely requires preauthorization.

Optional private insurance — through companies approved by Medicare — that covers most brand-name and generic prescription medications. Costs vary depending on the plan you choose and your medication needs. 

Part D coverage is available to those enrolled in Medicare Part A, B or Medicare Advantage plans that do not offer prescription drug coverage. The Medicare program Extra Help assists people with limited income and resources in paying for Medicare prescription drug coverage (Part D) premiums, deductibles and other costs.

• Cover your bases. Even if you don’t take prescription medications now, consider opting for a basic Part D plan. This can help you avoid the Medicare Part D late enrollment penalty, an extra monthly fee you pay if you don’t have drug coverage and wait too long to enroll. if you are still employed beyond age 65 and have group health insurance that includes prescription drug coverage as good as or better than Part D coverage (your group insurance company will notify you in writing that your coverage is “Credible”), you will not be penalized.
• During the Annual Election Period, which runs each year from November 15 through December 31, you may change prescription drug plans or add a drug benefit. There are certain situations which qualify for a Special Enrollment Period — these allow you to enroll outside of the Annual Coordinated Election Period without penalty.
• Because Part C and D plans are offered through private insurers, coverage rules may present issues for people living with chronic health conditions. Members may be required to use network providers and obtain prior authorization for some services or medications. This can delay or limit treatment access. Additionally, copays, deductibles and other out-of-pocket costs can outweigh the benefit of a low premium.

These private insurance policies help pay for many out-of-pocket costs associated with Original Medicare, such as the 20% coinsurance (after you meet your deductible) due on a Medicare Part B claim for a visit to the doctor. 

• Medigap coverage is only available to people enrolled in Medicare Parts A and B.
• Lock in guaranteed acceptance and the lowest rates. Your six-month Medigap open enrollment period begins on the first day of the month you are 65 or older and enrolled in Medicare Part B. During this time, you generally cannot be turned down or charged more because of preexisting health conditions. It is important to secure Medigap coverage during this window because it is the only surefire chance to secure coverage at the lowest price, regardless of your health.
• Your ability to obtain Medigap coverage may be limited if you are under 65 years of age and receiving Social Security due to disability. This is especially true if a policy has an exclusion for pre-existing conditions. Medicare Advantage plans (Part C), however, do not generally impose such an exclusion and are more accommodating to those with disabilities.

As you explore your options:

• Keep in mind three Medicare shortcomings:
  1. With limited exceptions, it generally does not cover medical care outside the U.S. 
  2. Medicare never pays more than its approved amount. Depending on your provider, you may need to pay charges above the Medicare-approved amount.
  3. After 90 days of inpatient hospital care in a benefit period, Medicare begins using your 60 lifetime reserve days — these can only be used once in your lifetime.
• A well-designed Medigap policy can protect against these gaps. However, not all Medicare Supplement plans cover all three limitations. AARP’s Medicare supplement insurance overview explores what to look for in a Medigap plan. Look for an option that covers:
  • Hospitalization expenses for up to a year or more beyond what Medicare allows.
  • Care received outside U.S. or Canada.
  • Eighty percent or more of the excess physician or surgeon charges not covered by Medicare (which you are still responsible for).
• Test-drive the plan you like best. See how well it covers your name-brand and generic drugs. If it doesn't meet your needs, change during open enrollment — from October 15 through December 7.
• Don’t buy a Medicare Advantage (Part C), Part D or Medicare Supplement (Medigap) plan direct from an insurer without an insurance agent. Choose an experienced independent broker who can guide you through the choices and make informed recommendations. There’s usually no added cost to you. 
• Visit the State Health Insurance Assistance Program (SHIP) at shiphelp.org. This federally funded network provides free, unbiased, one-on-one Medicare counseling.
• Check with your pharmacist. Many can tell you which Part D plans will cover all of the existing drugs you currently take.
• Original Medicare does not cover gym memberships or fitness programs, but some Medicare Advantage and Medigap plans may offer this benefit. 

For a deeper dive into Medicare choices, explore AARP’s Understanding Medicare’s Options. 

Despite the removal of the Medicare “therapy cap” in 2018, therapy denials and gaps in therapy coverage remain common. While Medicare no longer sets an annual limit on therapy coverage, providers must confirm therapy is medically necessary. This is often when patients begin to receive denials and may need to appeal.

Medicare costs can fluctuate annually and vary based on coverage, services and the providers you visit. Learn what Medicare costs and find ways to get financial help at medicare.gov/basics.

AARP explores what annual out-of-pocket costs for a typical Medicare enrollee look like here. 

This federal program administered by the states provides health coverage and long-term care for people with low-income and/or assets. If you are a qualified Medicare recipient the program ensures that you will still be able to receive necessary long-term care services if you exhaust your financial assets. 

A person must meet various eligibility requirements, including asset limits and level-of-care requirements to qualify for Medicaid to assist in paying for long-term care. Medicaid eligibility can vary state by state. While each state’s Medicaid program is based off federal Supplemental Security Income (SSI) program rules, state program designs may have different nuances.

For planning associated with accessing Medicaid benefits, you should seek the counsel of an experienced elder law attorney. The nonprofit National Academy of Elder Law Attorneys can help you find specialized elder law practitioners at Naela.org.

This is generally provided by and at least partially funded by an employer

• The employee usually has little or no choice of features.
• Coverage typically ends when the employee’s job ends. But there are options to continue coverage at your expense. (See COBRA and HIPAA.)

Health savings accounts (HSAs), special savings accounts created by the federal government, can help Americans save anywhere from 30% to 50% on out-of-pocket health costs. You must be enrolled in an HSA-eligible High-Deductible Health Plan to contribute to an HSA. Eligible contributions are 100% tax deductible. 

You can use an existing HSA account to pay for out-of-pocket Medicare costs but you will not be able to contribute to an HSA once you enroll in Medicare. Maximum contributions change annually. The IRS publishes these numbers every year. Visit the IRS Publication 969 page to check out the latest HSA tax rules and information on other tax-favored health plans.

• As of 2026, anyone age 55 or older not enrolled in Medicare can also contribute up to an additional $1,000 per person under what the government calls a "catch-up” amount. For up to date allowed HSA amounts, visit the Department of Treasury’s IRS Form 8889 page.
• You can use the dollars in your HSA to pay your deductibles if you need to, but you can also use those dollars to pay for just about any medical or dental expense that is not covered by your health plan, such as laser eye surgery, root canals and alternative medicines.
• HSAs advantages: 
  • Contributions can be made pretax through payroll or may be tax-deductible if made directly, lowering your taxable income. 
  • Earnings grow tax free and withdrawals are when used to pay qualified healthcare expenses, such as insurance deductibles, copayments and other medical costs, for the life of the account. 
  • Contributions not spent could become supplemental retirement dollars.
  • HSA withdrawals for 20% penalty and income tax until age 65. After 65, withdrawals used for non-qualified expenses are subject to ordinary income tax, but not the 20% penalty.
• For a current list of all IRS-approved medical and dental expenses, visit the IRS Publication 502 page.

You can also get coverage through the Health Insurance Marketplace, created under the Affordable Care Act. For those who retire or step away from work before the age of 65, the marketplace serves as a bridge until Medicare eligibility begins. 

• A Special Enrollment Period is triggered when job-based insurance is lost, so people can transition smoothly without a gap in care.
• The marketplace is a platform where you can compare and choose from various private health insurance plans created under the Affordable Care Act.
• Depending on income, you may qualify for financial help to lower monthly premiums and other costs, such as deductibles and copays.

Additionally, protections from the Affordable Care Act ensure people cannot be denied coverage or charged higher premiums because of a pre-existing condition, including Parkinson's, allowing people with Parkinson's to maintain continuous access to healthcare providers, medications and treatments.

The U.S. Social Security Administration (SSA) provides more than just retirement benefits — it provides a critical safety net for millions of Americans, including many with Parkinson’s. Programs available to help people unable to work due to disability include:

• Social Security Disability Insurance (SSDI) — a work-based program which may pay benefits to you (and certain family members) if you worked long enough and paid enough in Social Security taxes.
• Supplemental Security Income (SSI) — a needs-based program which may pay benefits to disabled adults and children who have limited income and resources.

In addition, people who have been eligible for Social Security benefits for 24 months are eligible for free Medicare Part A benefits, which can be invaluable to people with Parkinson’s. 

For most people, the medical requirements for disability payments are the same under both SSDI and SSI and disability is determined by the same process. In either case, the Social Security Administration asks for information about your medical condition, work and education history to help it decide if you meet its disability requirements.

Keep in mind that the SSA definition of disability stands on its own, separate and apart from the ADA definition or other contractual definitions that may apply to you in other contexts. You might be considered disabled under the SSA disability definition “if you are age 18 or older and have a medically determinable physical or mental impairment which:

• Results in the inability to do any substantial gainful activity; and
• Can be expected to result in death; or
• Has lasted or can be expected to last for a continuous period of not less than 12 months.”

Social Security won’t consider you disabled if you can do just about any gainful occupation or if you can work part time. This can make it difficult for people with Parkinson’s to collect benefits the first time they apply.

What you should know:

• Social Security may pay benefits to people who can’t work because they have a medical condition that’s expected to last at least one year or result in death.
• Generally, there is a five-month waiting period to receive disability payments once approved. Social Security pays your first benefit the sixth full month after the date it finds your disability began.
• Every year, Social Security mails a statement to people age 60 or older with estimates of future retirement and disability benefits.
• Everyone ages 18 or older can view their Social Security Statement online with a free and secure my Social Security account from the Social Security Administration. Use your account to request a replacement Social Security card, check the status of an application, estimate future benefits or manage the benefits you already receive. 
• After you receive Social Security disability benefits for 24 months, you will be eligible for Medicare.

Visit SSA.gov to learn more.

• Social Security Matters: The official Social Security blog, a resource for staying up to date on Social Security tools, online services and program benefits.
• Social Security Disability Programs: A webpage with information on the two disability programs, how to apply and what to do if your application is denied.

Many (but not all) employers pay for a base amount of life insurance for their employees:

• Basic coverage is often a flat amount — $50,000, for example — or a multiple of salary, such as one times or two times salary.
• Employees can usually buy additional life insurance through payroll deduction, subject to limited underwriting.
• If you're healthy and can qualify for individual coverage, it might make sense to pass on group supplemental coverage. Such coverage is often available for less cost on the open market. Unlike group coverage, individual coverage generally continues when your job ends.
• If you don’t qualify for individual coverage, take all the group coverage you can get. 
• Most group policies allow the option to convert to a more expensive permanent life insurance policy that you can continue indefinitely once employment ends.
• If you have Parkinson's and are leaving your job or going on disability benefits, it's important to keep employer life insurance coverage if possible, because you may no longer qualify for more affordable individual coverage.

This is generally available through a variety of policies to anyone who can qualify medically, including: permanent insurance designed to provide insurance coverage for the duration of your life (as long as premiums are paid), and term insurance, offering coverage for a certain period of time (typically 10, 20 or 30 years). Consider:

• Term insurance if you are covering your family during the childrearing years. It can be a fraction of the cost of permanent insurance.
• Permanent insurance if you're an aging care partner who wants to provide your spouse with Parkinson's a level of ongoing care if you die or become disabled.
• Many people in the early stages of Parkinson’s can still purchase life insurance, but will likely pay higher rates.

If you live with Parkinson’s and your spouse is or will be your care partner, buy more than the usual amount of life insurance coverage for them — enough to replace their income and to hire a caregiver for you.

With long-term care costs nearing $100,000 per year, this means buying at least $500,000 additional life insurance coverage on the caregiver.

Income replacement policies replace a portion of your income if you are unable to work. Disability income replacement generally only a provides a percentage of your earnings, up to the maximum outlined in your policy, and typically does not replace your full income. The essential claim for benefits under short-term or long-term disability policies is that you cannot do your job or work at all.

Keep in mind:

• Income replacement policies can be privately purchased (usually only prior to the onset of disability) or provided as an employment benefit. 
• If you have a work-provided policy, evaluate what options you might have if you must stop working at some point. Can you convert it into a private policy?
• Whatever type of policy you have, review it in detail. The definition of “disability” can vary from contract to contract. It is important to know what your contract says to know if and when you might be paid.
• It can be helpful to make a photocopy of your policy and highlight key terms in yellow. Highlight the reporting steps you must take in another color and the requirements you must meet to collect in a third color. 
• Identify what reporting obligations you might have to the insurance company and when they must be given. Do not risk inadvertently overlooking your obligations under the policy.
• The benefits, limitations and obligations of these policies are determined by the terms of the insurance contract (contractual), rather than established by law (statutory).
• As soon as you receive a Parkinson’s diagnosis or another situation impacts your ability to work, be sure to review what steps you must take to secure your benefits. If possible, have an attorney review the policy with you or meet with the agent who sold you the policy to better understand the terms.
• Typically, an income replacement policy will provide for the payment of a specified percentage of the person’s income, upon the occurrence of a triggering event, such as the onset of disability, for a specified number of years, provided that the policyholder remains disabled (as defined by the policy). 
• The policy may be structured to provide a short-term benefit for an initial period of time (such as 100% income replacement for 6 months), followed by a different benefit for the duration of the coverage (such as 70% until retirement).
• It is critical to know if your policy retains the same standard for “disability” over time. For people with Parkinson’s, policy nuances can make for a difficult planning process: Being awarded long-term disability for an initial period is not a guarantee that long-term disability benefits will continue.
• Taking steps to improve well-being, such as medication or surgery, could adversely affect your entitlement to the benefits under your policy.

This type of insurance can provide income if you are unable to work due to an illness or injury. Qualifying for a policy typically requires proof of good health. After a diagnosis of a major chronic illness, such as Parkinson’s disease, obtaining coverage may be difficult or prohibitively expensive.

A major advantage is that the policy can typically be kept to age 65 regardless of job changes. Among other advantages: 

• Long-term disability insurance is usually guaranteed renewable and price locked up to age 65.
• Benefits are tax-free because the premiums are paid with after-tax dollars.
• There is usually no offset for workers compensation benefits, which means you can collect both at the same time.
• There also is no offset (reduction) for group benefits you receive from an employer.
• You have the choice when purchasing a policy to decide whether to include an offset for Social Security benefits.

A good individual long-term disability policy should include:

• Ongoing partial income replacement benefits through age 65 if a disability reduces your working or earning ability.
• An option to regularly increase your coverage regardless of health.
• A cost-of-living adjustment rider that increases your benefits by around 4% to 5% a year while disabled.
• Broad-ranging choices of benefits and features.

If you cannot get either individual or group disability coverage on yourself due to a Parkinson's diagnosis, or if you are currently disabled and have a spouse, maximize disability coverage on your spouse if you are able.

If your spouse becomes disabled, they may lose their income and possibly the physical ability to help you as Parkinson’s progresses, requiring you to spend money for a care for yourself, and possibly your spouse.

Generally provided by the employer, new hires are typically eligible for coverage regardless of preexisting health conditions. However, typically preexisting health conditions are excluded either until the new employee has gone 12 months treatment-free or had coverage for 24 consecutive months.

Benefits are usually for 60% of salary, payable to age 65 if you are disabled, but are offset by any benefits received from workers compensation, Social Security or even any other group disability plan. Group disability benefits are taxable, which means a disabled person will end up taking home only about 45% of their salaries — not 60%.

Group disability shortcomings

• Coverage rarely includes a cost-of-living adjustment factor that increases benefits yearly to a person on a disability claim to keep up with inflation.
• Group disability also often does not include proportionate benefits for partial disabilities, known as "residual" disability coverage by the insurance industry. (A disadvantage for people with Parkinson’s who can often work part-time for many years before being totally disabled.)
• While some of these group policies do offer an option to convert the group coverage to an individual policy if you leave the job, the conversion coverage is usually less broad and the pricing higher. However, this can still be a good option for people living with Parkinson's.

If you have Parkinson's and are still actively working yet cannot qualify for an individual disability policy, one option is to seek a new position that offers group disability benefits that include coverage for preexisting conditions, residual/partial disability benefits and the right to convert to an individual policy if you leave the job for whatever reason.

Long-term care insurance, sometimes called nursing home insurance, can be an invaluable benefit for people with disabilities, especially those with progressive illnesses such as Parkinson’s disease.

The prospect of not having enough funds to live comfortably and safely as you age can be harrowing. A good long-term care insurance policy can help create a sense of calm about the future.

Before evaluating long-term care insurance coverage, you should first prepare a realistic budget and financial plan. For many people, coverage is too costly. It doesn’t make sense to purchase a policy you have to cancel it before you need it.

Some people simply do not need long-term care insurance coverage, as they have more than adequate resources to pay for the care. However, they may choose long-term care insurance coverage to protect their estate to leave to their children. 

As with income replacement policies and other insurance vehicles, the benefits of a long-term care insurance policy are contractual. Long-term care insurance policies are some of the most complex insurance policies to evaluate. The rates, future increases in rates, coverages, exclusion from coverage and more can vary significantly from one policy to the next.

The terms of the policy will govern when you are entitled to benefits and what you will need to establish your entitlement. Typically, long-term care insurance policies are triggered by a need for assistance of some significant level. A long-term care insurance policy will begin paying for care according to the terms of the policy. ]

If you have been diagnosed with Parkinson’s, carefully review your long-term care insurance policy as soon as possible. When people first purchase long-term care insurance coverage they often focus on cost, maximum benefits, the quality of the carrier and other factors. A Parkinson’s diagnosis can shift your focus to understanding:

• Whether the policy is in good standing
• If you must continue to make premium payments
• Are there policy options which could affect coverage 
• What are the specific triggers for collecting

In shopping for long-term care insurance policies, or later for applying for benefits, it is important to know the specifics of your policy, not only for the triggering event(s), but also how the benefits may be used.

• Many long-term care insurance policies will pay for care while you still live at home. 
• Long-term care insurance policies are typically capped at a contractual dollar amount and will only pay up to the limits of your policy. For many people, they are of great help, but not a financial solution. In the case of a progressive illness such as Parkinson’s, the types of services policies cover can burn through your eligible benefit quickly. 
• Don’t only consider long-term care insurance for the person with Parkinson’s but also for a spouse or care partner. If you cannot qualify for new or additional coverage, your spouse may.
• Because of changes in the long-term care insurance market, many life insurance policies are now available that include long-term care riders. You should investigate the benefits of these alternatives as well.
• You may qualify for an income tax deduction for the premiums you pay on long-term care insurance policies.

Tip: Even if you did not keep track of medical expenses or long-term care insurance premiums for deductions in the past, once you have been diagnosed with Parkinson’s your medical expenses might increase, and your income might decrease, so that you may now qualify for a deduction. Be careful in preparing this year’s income tax return based on last year’s (or preparing information for your accountant based on an organizer with last year’s information) since changed circumstances might change your ability to claim these deductions.

You might not need long-term care insurance if:

• Your assets are so minimal that you qualify for the Medicaid program or you're willing to spend down your assets until you qualify for the program.
• You are financially independent enough to cover the long-term care costs out of your investment earnings without depleting the principal much.

Ensure the company you choose:

• Has received an A+ or A++, the highest financial rating by the AM Best Company. Rating information is available at www.ambest.com and your local library. You want an insurer solid enough to be around 30 years from now when you need the coverage.
• Has a history of taking only modest rate increases on existing policies. With long-term care costs rising faster than the rate of inflation, companies with a history of large rate increases could raise your premium to the point where you have to drop the policy because you can no longer afford it. The agent you are working with can provide this rate-change history for you.