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Medicare Coverage for Epilepsy

Medicare covers benefits for those diagnosed with epilepsy. When you receive care, you may be required to pay a deductible, copayment, or coinsurance depending on the service and which part of Medicare is paying your benefits. Epilepsy can be a scary diagnosis. However, the disease can be controlled with the use of proper medication. Thus, Epilepsy is one of Medicare’s Six Protected Classes. This means that you receive extensive drug coverage regardless of the Medicare Part D plan you enroll in.

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Below, we’ll answer some common questions about Medicare coverage for epilepsy.

What is Epilepsy?

Epilepsy is a neurological disorder that affects the brain’s activity, causing recurrent seizures or convulsions. Seizures occur when there is a rapid surge of electrical activity in the brain, causing a disturbance in the normal functioning of the brain.

Epilepsy can have many different causes, such as genetic factors, brain injuries, infections, and abnormal brain development. Epilepsy can affect people of any age, but it is commonly diagnosed in older adults.

There are several types of seizures, and they can have different effects on different people. Some seizures may cause a person to lose consciousness or fall to the ground, while others may cause involuntary movements, sensations, or emotions.

Treatment for epilepsy typically involves medication to control seizures, but in some cases, surgery or other therapies may be necessary. It is important for people with epilepsy to work closely with their healthcare providers to develop a treatment plan that is tailored to their individual needs.

Does Medicare Cover Epilepsy?

Original Medicare (Medicare Part A and Part B) covers medical benefits for people with epilepsy. Medicare coverage includes diagnostics, preventive, inpatient, and medical care. Medicare Part A covers inpatient and hospital care. But, outpatient doctor bills and medical equipment fall under Part B.

Then, Medicare Part D plans cover epilepsy medications. Good healthcare is critical for epilepsy patients, and treatment is specific to the individual. Let’s take a look at the specifics of Medicare for those with epilepsy.

Additionally, Medicare Advantage (Medicare Part C) and Medicare Supplement (Medigap) plans can be purchased to help cover out-of-pocket costs or additional benefits related to epilepsy. Each part of Medicare works together to provide you with the best coverage for your needs.

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Does Medicare Cover Deep Brain Stimulation for Epilepsy?

Medicare may cover deep brain stimulation (DBS) as a treatment for epilepsy if the service is deemed medically necessary by your treating physician. However, your coverage may vary depending on several factors, including your specific diagnosis, the type of DBS device used, and your physician’s recommendation.

DBS involves the implantation of a small device in the brain that delivers electrical impulses to specific areas of the brain to control seizures. Medicare Part A may cover the hospitalization and surgery costs associated with DBS, while Medicare Part B may cover the device itself and any necessary follow-up care.

However, Medicare generally covers DBS for epilepsy only in cases where other treatments have been ineffective and the patient has been diagnosed with a specific type of epilepsy that is known to respond to DBS therapy. Additionally, Medicare may require that DBS for epilepsy be performed at a Medicare-approved facility and by a Medicare-approved provider.

As with any medical treatment, it is important to consult with your healthcare provider and Medicare to determine whether DBS is covered in your specific case and what costs may be associated with the treatment.

Is Epilepsy Considered a Disability?

An epilepsy diagnosis doesn’t automatically make you Medicare-eligible. To qualify for Medicare, you must receive Social Security Disability for at least 24 months. If your epilepsy causes you to become unable to perform the daily tasks of your job, you may qualify for disability. However, disability is awarded on a case-by-case basis after a thorough review of your medical history.

The Social Security Administration then makes a case-by-case decision based on the facts of your case. They look at how your condition affects your ability to work and hold a job. However, if you are approved, you’ll become eligible for Medicare coverage on your 65th birthday, or the month you receive your 24th disability check, whichever comes first.

Medicare Coverage of Laser Ablation Surgery for Seizures

Medicare may cover laser ablation surgery as a treatment for seizures depending on your situation. Laser ablation surgery is a minimally invasive procedure that uses laser technology to destroy brain tissue that is causing seizures.

Medicare usually covers medically necessary services and procedures. So, if your doctor says you need interstitial thermal therapy, it’s likely that Medicare will cover it. Now, if you have a Medicare Advantage plan, coverage will likely vary.

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Does Medicare Cover Electroencephalogram?

An Electroencephalogram (EEG) can be done to diagnose and treat epilepsy. The non-invasive test can show the region of the brain that has abnormal activities.

Since this is a diagnostic lab test, Medicare will cover the full cost. However, in some cases, you may be responsible for a small copayment or deductible. Also, Medicare Advantage plans should provide full coverage when this is necessary for diagnosis or treatment.

Medicare Part D Epilepsy Drug Coverage

Medicare Part D will cover medications for many conditions. But it’s your responsibility to make sure your prescribed medications are on the formulary of the plan you enroll in.

Epilepsy patients rely on medications to control and limit epileptic seizures. Numerous antiepileptic or anticonvulsive drugs are available. Different medications are effective for different people, and side effects can vary.

Further, anticonvulsants for epilepsy are among six classes of drugs protected under Part D. All plans must cover the drugs in protected classes. Patients must have the right to seek all medications available to treat their condition.

While there are protections to keep these medications available, there are barriers to care, including high cost-sharing that can limit access to lifesaving medications. Now, the Low-Income Subsidy or the Extra Help program can help low-income beneficiaries gain access to medications.

Does Medicare Special Needs Program Cover Epilepsy?

A Special Needs Plan (SNP) is a Medicare Advantage plan for people with a chronic medical condition. Special Needs Plans can be a good option for people with epilepsy. These plans are made to give people with specific chronic conditions access to care that’s necessary. Like, specific specialists and medications for the condition.

However, Special Needs Plans are not available in all areas, and if you wish to enroll in a Medigap plan, you won’t be eligible for an SNP.

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Medigap Epilepsy Coverage

Since Original Medicare covers epilepsy, all Medicare Supplement (Medigap) plans will cover it as well. But, if you are under 65, it can be hard to get Medigap coverage, so you’ll need to be sure you enroll in the best plan for you.

In some states, there are no Medigap plans for people under 65. Further, in most states, they cost more than Medigap for people over 65. However, if Medigap is an option for you, they are a great way to reduce your out-of-pocket costs.

How to Get Extra Medicare Coverage for Epilepsy

At MedicareFAQ our team of licensed Medicare agents can help you find the best plan for your budget and health needs.

We can provide quotes, compare plan options, and answer any questions you may have to ensure you enroll in the right plan the first time. Our team provides you with the information you need to make the right decision.

Give us a call today at the number above. If you can’t call, fill out our online rate comparison forms to learn more about Medicare epilepsy coverage and more!

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

3 thoughts on "Medicare Coverage for Epilepsy"

    1. Hi Beverly! As long as the person giving the test is approved by Medicare it should be covered. You would need to check with your local Medicaid office to find out if Medicaid would cover it at home.

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