7 Ways to Navigate Your Health Insurance With MS

October 2025 – by Chloe Franklin

The National Multiple Sclerosis Society is here to help you find resources and information that can help you navigate your healthcare coverage while living with multiple sclerosis. Between finding the right coverage and knowing where you can save a few dollars — take a look at some tips to help you make the most of your health insurance. Let’s get started!

Tip #1: Know When You Can Enroll

Open enrollment is an annual period where individuals can modify their health benefits. This is a great chance to reevaluate and make informed decisions about your coverage for the next year. The Annual Medicare Open Enrollment Period is from Oct. 15 – Dec. 7 and open enrollment for states that use the federal Marketplace will be Nov. 1 – Jan. 15. Please remember, if your state has its own Marketplace, the dates may vary. Job-based health insurance is a coverage that you receive from an employer or union, and it varies from plan to plan. With this type of insurance, your place of employment will typically pay for most of your insurance premium while you contribute a portion. Find out more about job-based health insurance. Job-based insurance provided through your employer will have its own annual open enrollment period. The dates and deadlines of this enrollment period will vary. Contact your Human Resources department for details specific to you.

Tip #2: Check To See if You Qualify for Medicare or Medicaid

Medicare is the federal program that serves as the primary source of health insurance for people 65 or older and many people with permanent disabilities. People with multiple sclerosis can qualify for Medicare coverage before age 65 if they have been determined permanently disabled by Social Security and received Social Security Disability benefits deposits for 24 months. Visit our Medicare webpage to learn more about how this program works and take our quick test on your knowledge of Medicare. Medicaid works a little differently. Rules are different from state to state. Most states will offer coverage for adults below a certain income level who have children, as well as pregnant people, some seniors and people with disabilities. Learn more about Medicaid and how to qualify. Please note, if you qualify for both Medicare and Medicaid, Medicare is the primary payer. Medicaid is the secondary payer for all other medically necessary costs not covered by Medicare.

Tip #3: Look Into a Health Savings Account

A Health Savings Account (HSA) is a type of savings account that lets you set aside money to pay for certain health care costs. The money isn’t taxed as long as you use it for qualified medical costs. HSAs can lower some of your out-of-pocket healthcare costs including for spouses and dependents. Keep in mind, you can only contribute to an HSA if you have a qualifying plan (typically this is a plan with a high deductible) and you can’t contribute to an HSA if you have Medicare coverage. See how you can enroll in this type of account.

Tip #4: Understand the Different Types of Health Insurance Plans

4 common types of health insurance plans help you get and pay for care differently:

• Exclusive Provider Organization (EPO) is a plan where most services are covered as long as you use in-network providers.
• Health Maintenance Organization (HMO) is a plan that will typically limit your coverage to care from providers who work for the HMO. This type of plan generally won’t cover out-of-network care except for emergencies.
• Point of Service (POS) is a plan where you pay less if you use healthcare providers or services that belong in-network but require you to get a referral from your primary care doctor to see a specialist.
• Preferred Provider Organization (PPO) is a plan where you pay less if you use providers in-network. You can see out of network providers for an additional cost.

Tip #5: Explore Private Health Insurance Options

Private insurance is typically for people who are self-employed or ineligible for insurance from other sources. You can receive individual health insurance by looking into the Health Insurance Marketplace, where users can compare available health plan options and more. All individual insurance plans sold through the Marketplace are available on an income scale. Read how you can benefit from individual health insurance.

Tip #6: Consider Prescription Assistance

If you need help with medication costs, you may be able to find support from certain pharmaceutical companies’ drug programs.With or without insurance, paying for prescriptions can be pricey. Drug cards can lower out of pocket costs at the pharmacy for symptom management medications or some MS disease-modifying therapies. See how you can qualify for assistance, no matter what type of coverage you have.

Tip #7: Appeal Denied Insurance Requests

You don’t have to take “no” for an answer if your health insurance denies your first request for coverage. Work with your healthcare provider to file an appeal. Only 1 in 10 denied requests were appealed in 2022, according to one study of Medicare Advantage insurers. And yet over 80% of health insurance appeals succeed in partially or fully reversing the denial, according to a 2024 AMA article. So, it’s well worth the time and effort to appeal!

Check out our appeals templates and resources to share with your provider as you start this process.

Continue reading