Does Medicare cover Botox for migraines?

Does Medicare cover Botox for migraines? Like other health insurance companies, Medicare will cover Botox for migraines when other migraine treatments for patients have failed, and when you have chronic (not occasional) migraines. The pain from a migraine is nothing to take lightly, and having a variety of options can make it easier to treat.

Botox for migraine treatment is covered under Original Medicare Part B, and subject to that deductible and coinsurance. If you have a Medicare Supplement plan, you can get the out-of-pocket expenses covered in whole or in part depending on your plan.

Medicare Advantage plans will also cover migraine Botox treatment. Deductibles and coinsurance amounts will vary. If you suffer from chronic migraines you may want to look at this as an option. Should you feel as though your symptoms go beyond regular headaches, you would first need to be diagnosed with chronic migraines before getting the go-ahead from your doctor to receive Botox as one of your treatment options.

If you’d like to compare Medicare options to cover Botox for migraines, enter your ZIP code now for free quotes.

What coverage is available with Medicare for Botox?

Botox injections are only covered by Medicare for medical uses that are FDA-approved. Although it’s commonly known as a cosmetic procedure, Botox has been approved by the FDA as a treatment for certain conditions, including migraines. Botox is derived from a toxin that can weaken or paralyze muscles and nerves. It can be used to treat conditions like overactive bladder, cervical dystonia, and eyelid spasms.

Botox treatment for migraines involves multiple injections. Medicare will cover this treatment for those who have chronic migraines, occurring at least 15 times a month. Coverage will also require that other migraine medications and treatments have been attempted first without success.

Your doctor will have to prescribe the treatment, which usually includes monitoring your medical conditions. A standard headache and neck pain won’t be enough for you to receive Botox as part of your insurance plan. As mentioned above, people who suffer from chronic migraines often have them multiple times a month.

Coverage for Botox under a Medicare Advantage plan will generally be much the same, although plans do vary. Check with your Advantage provider for details.

What is the cost of Botox for migraines with Medicare?

Since Botox treatment for migraines is covered under Part B, it will be subject to your Part B deductible. You will also have to pay a coinsurance amount of 20 percent. If you have a Medicare Supplement plan, deductibles and coinsurance amounts can be covered, but how much will depend on the plan you choose.

The average cost of a Botox treatment for migraines is $300-$600 according to the American Migraine Foundation, and you will likely need repeated treatments for up to six months for maximum effectiveness. The number of treatments will determine the final cost.

Medicare Advantage plans have varying deductibles and health care coinsurance amounts, so the out-of-pocket cost to you will depend on what your plan benefit schedule looks like. Contact your Medicare Advantage company for details on your costs.

The Bottom Line: Will Medicare cover Botox for migraines?

Medicare will cover Botox as a treatment for migraines as long as you meet the criteria. If you want Botox covered by Medicare, you will need to suffer from chronic migraines, which means your doctor will need to sign off on the diagnosis. Your out-of-pocket costs will include your Part B deductible and 20 percent coinsurance. Medicare Supplement insurance can help to pay those costs.

To compare rates and plans for Medicare Supplement insurance that covers what Medicare doesn’t for Botox migraine treatment, enter your ZIP code now.