Medicare has been our nation’s health insurance program for seniors since 1965. According to the National Committee to Preserve Social Security and Medicare, it covers more than 56 million people in the United States, . This includes some people under 65 who are on Social Security disability income. But does Medicare cover migraine?
Originally, Medicare was created with two parts that provided inpatient and outpatient coverage. Today, it remains much the same as it was at its inception. However, in 2006 a prescription drug program was added to Medicare, and this has been very helpful in providing prescription coverage for migraine medication as well as many other health conditions.
Medicare will cover migraine services that are deemed medically necessary by your doctor for treatment and for symptom relief. There are several different parts of Medicare that cover these treatments.
Medicare Part A & Part B
Hospital services are covered under Medicare Part A. This includes inpatient stays, but it also covers skilled nursing facility and hospice care, blood transfusions and even some home healthcare immediately after a hospital stay. If you were to be hospitalized due to a severe migraine, Part A covers the first 60 days in the hospital after you satisfy a $1340 deductible.
Outpatient services are covered by Medicare Part B, and this is where many of the treatments for migraines fall. Part B covers visits to your doctor, lab-work, imaging scans, ambulance, E.R. visits and much more. Injections given in a clinical setting or doctor’s office, such as Botox for migraines, are covered by Part B as well.
When you seek treatment with a physician for migraines, Part B will cover 80% of the cost of both your doctor visit and the treatment provided. You are responsible for an annual deductible of $183 for 2018 under Part B. You will also be responsible to pay the other 20%, which is called your coinsurance.
If you visit with your doctor about migraines, Part B will pay for 80% of the cost of your appointments after once you’ve met your annual Part B deductible. In 2018, that deductible is $183. You are responsible for the other 20%, unless you have a Medigap plan, which is an insurance policy designed to help you pay for the gaps in Medicare.
Medicare’s “New” Drug Program
There are a number of medications that your physician may prescribe for migraine treatment. Prior to 2006, Medicare would have provided coverage for such treatments. However, Medicare Part D now offers voluntary prescription drug coverage for people on Medicare.
Part D plans are private insurance policies that help you to pay for retail outpatient medications. Each company has its own formulary of drugs, and it’s important to review that list before you enroll to make sure that it covers the migraine medications you need.
Most formularies contain a number of options for migraine treatment such as beta blockers, triptans, and glucocorticoids. It is also hoped that Medicare Part D will soon begin to cover newer preventive medications like calcitonin gene-related peptides, such as Aimovig, which was just approved by the FDA.
Danielle Kunkle is the Vice President and Co-Founder of Boomer Benefits, a licensed insurance agency that assists Medicare beneficiaries with their supplemental plan options. You can read more about what Medicare covers on her website: https://boomerbenefits.com