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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.
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.
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.
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.
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:
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.
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?