A common question many people have is, “Does Medicare cover Lyme Disease Treatment?”
In this article, we answer the question as best we can (as you’ll soon see, it’s kind of a complicated topic!). You will also find some ideas on getting financial help for Lyme disease.
Does Medicare Cover Lyme Disease Treatment?
Unfortunately, there is not a short, easy answer here. Much of this comes down to the mystery and disagreement over the disease itself.
First thing to know is there are 2 different types of Lyme disease. But only 1 is officially recognized by the government and most insurance companies.
Acute Lyme Disease
That is Acute Lyme disease. This is when someone gets a tick bite and, within a few days, develops flu-like symptoms. And, most of the time, they’ll have the telling “bullseye” rash Lyme disease is famous for.
For Acute Lyme disease, both testing and treatment can be covered by medical insurance. For acute cases of Lyme disease, if a doctor says it is medically necessary, you may be able to have Medicare cover testing and treatment.
Chronic Lyme Disease
That brings us to Chronic Lyme disease. This variation of the disease has a number of different symptoms including fatigue, joint pain, muscle aches and even some more serious heart and neurological problems.
At the moment, insurance companies and the CDC in the US do not consider chronic Lyme disease to be a legit disease. They say it does not exist.
Part of this is due to the fact that it is hard to diagnose. And many times other conditions are misdiagnosed as being chronic Lyme disease.
Another part of it is that treating chronic Lyme involves long term, costly procedures that many say have little, if any, effect on a patient’s health.
So, for Chronic Lyme disease, do not expect Medicare to provide coverage.
As for Medicare Advantage plans, they cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what they cover and how much the out-of-pocket costs are will vary depending on the specifics of your plan.
Bottom line here is, if you want to find out about Lyme disease coverage, contact your plan provider.
Financial Help For Lyme Disease Treatment
If you can’t get Medicare coverage for Lyme disease, all hope is not lost. Thankfully, there are a couple of organizations that may be able to help financially. Here are some of the organizations that can help you with your financial issues when it comes to treating Lyme disease:
- The Lyme Light Foundation: This foundation can help up to $10,000 for individuals and $30,000 for families who are in financial need
- The Lyme Test Access Program (Lyme-TAP): This program reimburses up to 75% of the out-of-pocket costs of your Lyme disease tests
- LymeAid 4 Kids: This program, which is under the Lyme Disease Association, provides up to $1,000 for Lyme disease diagnosis and treatment to those who are under the age of 21
- NeedyMeds.org: This website may help in finding programs that can help people with their financial related medical issues.
- GoFundMe: GoFundMe is a fundraising platform that allows people to donate money to those who are in need
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 an echocardiogram?