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Medicare Coverage for Epilepsy


Medicare coverage includes benefits for those with epilepsy. But, some things cost a copayment or coinsurance depending on the service. Also, sometimes there will be a deductible that needs to be met before coverage begins. Below, we’ll answer some common questions about Medicare coverage for epilepsy.

Does Medicare Cover Epilepsy?

Medicare covers care for people with epilepsy. Coverage includes diagnostics, treatment, hospital, and medical care. Part A covers inpatient surgeries.  But, outpatient doctor bills fall under Part B. Then, 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.

Does Medicare Consider Epilepsy a Disability?

An epilepsy diagnosis doesn’t automatically make you Medicare eligible. To get Medicare, you must qualify for Social Security Disability. The Social Security Administration makes a case-by-case decision. They look at how your condition affects your ability to hold a job. But, if you get disability benefits, you’ll be eligible for Medicare 24 months after becoming eligible.

Does Medicare Cover Deep Brain Stimulation for Epilepsy?

Yes, Medicare covers deep brain stimulation for epilepsy, including essential tremor treatment. Deep Brain Stimulation involves surgically implanting electrodes in the brain.

Medicare approves Deep Brain Stimulation for patients that don’t respond to seizure medications. Patients will spend a couple of days in the hospital following the electrode implant surgery but will have the pulse generator surgery as an outpatient.

Does Medicare Cover Laser Ablation Surgery for Seizures?

Thermal ablation is known as interstitial thermal therapy. Medicare doesn’t have a National Coverage Determination for laser interstitial thermal therapy. Also, Local Coverage Determinations don’t exist either. Yet, 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.

Now, if you have a Medicare Advantage plan, coverage will likely vary.

Does Medicare Cover an EEG or 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. Also, Medicare Advantage plans should provide full coverage when this is necessary for diagnosis or treatment.

Does Medicare Part D Cover Drugs for Epilepsy?

Part D will cover Medications for many conditions. But, it’s your responsibility to make sure your medications are on the formulary. 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 is a Medicare Advantage plan for people with a chronic medical condition. Also, 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.

Does Medigap Cover Epilepsy?

Yes, since Medicare covers epilepsy, Medigap will cover it too. But, if you are under 65, it can be hard to get Medigap coverage. 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.

FAQs

Does Medicare pay for transportation for people with Epilepsy?
Medicare pays for necessary emergency transportation. But, it doesn’t pay for transportation to doctor’s offices or other medical appointments.
Will Medicare cover vagus nerve stimulation for Epilepsy?
In vagus nerve stimulation, a pacemaker-like device is implanted in an epilepsy patient’s chest. The device sends mild electrical pulses to the brain through the vagus nerve in the neck. Medicare covers vagus nerve stimulation for epilepsy patients whose conditions can’t be controlled by medication and aren’t candidates for surgery or have had a failed surgery.
Is Medicare free for people with Epilepsy?
Part A’s is free for most people. Part B comes out of your Social Security check. Further, you’ll pay copayments and coinsurances after you meet your deductibles. But, about a third of people with epilepsy qualify for Medicaid.

How to Get Extra Medicare Coverage for Epilepsy

Our team of 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. Our team provides you with the information you need to choose the right option.

Give us a call today at the number above. If you can’t call, fill out our online rate comparison forms.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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