Medicare Coverage for 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.

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.

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.

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.

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.

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.

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.

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.