Does Medicare Cover Botox for Migraines?

Does Medicare cover Botox for Migraines? – Overview

Migraines are a type of headache. It causes several pulsing sensations and throbbing pain.

This condition often causes nausea, vomiting and induces hypersensitivity to bright lights and loud sounds.

Some migraine attacks can last for hours and even days. At times, the pain is so severe that it drastically affects your day-to-day life.

Botox was approved for treating chronic migraines in adults in 2010. If you suffer from bouts of migraine or suffer from prolonged headaches, then Botox can help you to get relief.

Botox is a type of neurotoxin, which helps block neurotransmitters (chemicals that carry signals from the brain).

This way, you can prohibit the neurotransmitters from reaching the nerve endings on your neck and head which usually cause migraine.

In some situations, Medicare can cover the cost of Botox treatment for migraines. However, there are strict guidelines for receiving Botox injections.

Their cost is also significant. Hence, it is highly advisable to do your research and consult with your doctor to ensure your Medicare plan covers Botox for migraines.

Medicare coverage for Botox

Medicare does not cover the cost of injecting Botox for cosmetic reasons. However, Medicare does cover the cost of Botox treatment if it is deemed medically necessary.

For instance, Medicare does not pay for Botox injections to remove signs of aging for aesthetic reasons.

Medicare coverage for Botox

However, Botox is also deemed medically necessary by doctors to prevent or treat several health conditions.

In such cases, Medicare usually covers the cost of Botox injections. Medicare covers the cost of Botox injections to treat severe, chronic migraines.

If you suffer from daily headaches (min. 15 days a month, lasting for 4 or more hours) for at least 3 months, then you are eligible for Medicare benefits.

It is important to prove a significant decrease in the frequency of headaches and improvement in functions after receiving the Botox injections.

Additionally, you also need to prove that you suffered noticeable disability due to the severity of the chronic headaches.

Getting Medicare Cover for Botox to Treat Migraines

Insurance coverage is not always assured. However, there are certain steps you can take to ensure that the Botox treatment is covered, such as:

Have your Medicare-approved doctor submits a request to Medicare detailing why Botox is medically necessary for your migraine treatment
Send your migraine medical reports to Medicare, including proof of diagnosis, symptoms, and failure of other treatment methods

You should consult with your doctor regarding the documentation and information you will need to provide to Medicare. You will also need to call Medicare directly to ensure that your application is successfully submitted.

Make sure to inquire about all necessary documents you need to submit to Medicare and any other steps you may need to take.

Cost of Botox for Migraine Treatment

The cost of Botox injection therapy for treating migraines varies. It usually depends on the number of sessions you need and the amount of Botox to be used in each session.

On average, the cost of Botox treatment is as low as US$ 300 to as high as US$ 600 for each session.

Usually, Medicare will pay around 80% of the total Botox treatment cost while you will have to bear the remaining 20%. Remember, Botox is only a temporary treatment for migraines.

Hence, you should be prepared to undergo another treatment after some time. For every treatment session, be ready to pay 20% of the treatment cost from your pocket.

To remedy this, you can buy the Medicare Medigap (Supplement) plan. This plan may help pay for the co-payment costs or the co-insurance costs you might have paid for the treatment.