When it comes to Botox and Medicare, things get a little complicated. There are cases when Original Medicare will provide coverage for Botox. When it is used as a cosmetic procedure, then Medicare definitely will not provide coverage.
However, Botox is an increasingly common treatment for migraines. Which begs the question… “does Medicare cover Botox for headaches?”
This article will answer that question in clear, plain English. You will also find the average costs of botox treatment if you have to pay out of pocket as well as some other helpful information.
Does Medicare Cover Botox For Headaches?
The short answer is yes; Medicare will cover the cost of Botox as a treatment for headaches. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your Botox treatment. Below we look at what these conditions are so you know what to expect.
Original Medicare Coverage
Original Medicare (Medicare Part A and Part B) provides coverage for Botox as a treatment for headaches. This plan provides coverage for your Botox treatment if it is considered medically necessary. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Most of the time, Original Medicare does not provide coverage for Botox therapy. However, if it will be used for treating any headaches, usually migraines, then they will provide coverage. Original Medicare also provides coverage for Botox treatments for some other medical conditions.
Now, there are certain cosmetic Botox therapies that are medically necessary. That is the case if your cosmetic Botox surgery will take place due to an accident or injury.
Once approved, coverage for medically necessary Botox treatment is provided by Medicare Part B.
Medicare Part B will cover 80 percent of the costs of Botox treatment for headaches. You will pay for the remaining 20 percent as coinsurance.
Part C Coverage
Medicare Advantage plans (Medicare Part C) also provides coverage for Botox treatment for headaches. These plans have to cover everything Original Medicare covers, though they will also offer some additional benefits as well.
What additional benefits a plan covers and how much the out-of-pocket costs are will vary depending on the specifics of your plan.
Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you.
How Much Does Botox for Headaches Cost?
Botox usually costs around $10 to $15 per injection if you have to pay out of pocket. Your total cost will depend on how many injections you need.
When Should You Use Botox As A Treatment For Migraines
The FDA only recommends Botox as a treatment for headaches if the headache lasts for 15 or more days. It is not recommended for headaches that do not last longer than 15 days.
The best way to know if Botox injections are the most suitable treatment for your migraines is by checking in with your health care provider. He or she will be the one who will determine if Botox treatments is right for your situation.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare Cover Eye and Dental?