ORIGINAL MEDICARE
In this day and age, there is such a variety of options when it comes to medical treatment. Each year brings new forms of medical advancements around the world for the treatment of all kinds of medical conditions.
While not a relatively new treatment option, Botox is purposeful not only for cosmetic reasons but now also for palliative care.
Botox is derived from a neurotoxin called botulinum toxin that is composed of a bacterium. The bacterium is found in our natural habitat, including soil, bodies of water, forests and the intestinal tracts of mammals and fish.
Botox comes in a small concentration of a dry powder-like substance. It’s combined with sterile saline to form the injectable solution. When injected, it prevents the nerve cells from transmitting signals to the affected muscle(s), therefore paralyzing the area.
While Botox is technically considered poisonous, when used in small doses it can be beneficial for an assortment of conditions.
Medicare Guidelines for Botox Treatments
The most popular and predominate use for Botox over the years has been for cosmetic purposes. For the last 15 years, men and women globally, have been opting to use Botox and injectable fillers rather than having more invasive procedures like facelifts and other cosmetic surgeries.
When injected, it temporarily diminishes the appearance of fine lines and facial wrinkles leaving the skin smooth.
Because of the temporary paralysis of muscle with Botox use, there have been scientific studies over the years to prove effectiveness for multiple medical conditions.
Botox injections have been approved by the U.S. Food and Drug Administration to treat:
- Overactive bladder
- Cervical Dystonia (severe neck spasms)
- Chronic migraines
- Crossed eyes
- Excessive underarm sweating
While the upside of using Botox leaves you looking younger and with an aesthetically pleasing outcome, the downside is the cost.
Does Medicare Cover Botox Treatments
Yes, Medicare will cover Botox treatments if found medically necessary. Medicare policy for Botox states that other treatments for any medical condition must have been tried and unsuccessful before you can get Botox treatments approved by Medicare.
Does Medicare Part B Cover Botox
For Medicare beneficiaries, there is some good news. If your treating physician deems Botox treatment as medically necessary, the procedure can be covered by Part B under Medicare.
In most cases, insurance requires the patient to have tried and failed all conservative care prior to approving the costly, alternative treatment. Once approved, Medicare will cover the injections at 80%.
Does Medicare Part D Cover Botox
In addition, a Part D Plan can provide a small portion of coverage for this treatment as it does require a prescription from your healthcare provider.
Does Medicare Cover Botox for Migraines
Yes, Medicare will cover Botox treatments for Migraines. The FDA has approved Botox for the treatment of chronic migraines.
However, it may only be prescribed by your physician after other treatments have been exhausted.
Does Medicare Cover Botox for Overactive Bladder
Yes, Medicare will cover botox for overactive bladders. Many people don’t know that Botox is also a great treatment for overactive bladders.
Over 44% of Americans over the age of 65 experience some type of urinary incontinence.
Botox for Hyperhidrosis – Will Medicare Cover It
Yes, if found medically necessary Medicare will cover Botox for Hyperhidrosis. Only if managing with topical agents has been unsuccessful.
Does Medicare Pay for Botox Injections for Cervical Dystonia
Yes, if found medically necessary Medicare will cover Botox for Cervical Dystonia.
Botox has been found to reduce the severity of abnormal head position and neck pain associated with Cervical Dystonia.
Botox Reimbursement from Medicare
Reimbursement from Medicare is not common. In rare cases your doctor does not bill Medicare directly, you have to submit a reimbursement form.
If you feel entitled to receive a reimbursement from Medicare for botox treatments, you can read more about reimbursement here.
Get Help Paying the Out of Pocket Costs of Botox
With Botox already being costly, based on how many units are required for treatment will determine your 20% remaining OOP cost. And as Botox only provides temporary relief, the injections will need repeating every 4-6 months. This can add up quickly over time.
Medicare Supplement Plans are vital in scenarios like this. They pick up the remaining 20% coinsurance, deductibles and copayments not covered by Original Medicare. Having a supplemental plan may help offset some of the cost associated with interventional procedures like Botox.
Fill out our online form or call us today. Our licensed insurance agents can help answer questions regarding the various Medicare plans including cost and coverage.
