Does Medicare Cover Your Migraines?

Addison McNatt General, Medicare Leave a Comment

Most of the 4 million Americans who suffer from migraines are between the ages of 18 and 44. These severe headaches usually diminish in later life but can still be a cause for concern for seniors. Migraines are reported in 17% of those over age 65 and may indicate a more serious underlying condition. 

If you experience migraines, consult with your doctor for diagnosis and treatment. You may even be able to use your Medicare benefits to cover some of the cost!

Migraine symptoms and treatment

A migraine is defined as a severe, recurring headache that can last for hours or even days. Those who have these headaches chronically can show symptoms for around 15 days out of the month. If you are experiencing these symptoms, check with your physician as soon as you can. The most common symptoms are:

  • Throbbing pain on one or both sides of the head
  • Blurred vision or sensitivity to light
  • Nausea or dizziness
  • Confusion

Treatment Options

The primary treatment method for migraines is medication, both for relief and prevention. Your doctor may prescribe one or more of these medications depending on your diagnosis and symptoms. 

Abortive migraine medications are used to relieve the symptoms of severe headaches as they occur.  Some of these target serotonin in the brain to treat migraines directly, while others are used to treat individual symptoms. Some are available over-the-counter. 

These abortive medications include:

  • Almotriptan (Axert)
  • Sumatriptan (Alsuma, Imitrex)
  • Zolmitriptan (Zomig)
  • Acetaminophen
  • Chlorpromazine (for treating nausea)

In cases of severe or frequent symptoms, your doctor may prescribe preventive migraine medications. These are meant to diminish the regularity and intensity of migraines before they happen. 

Antidepressants and high blood pressure medications are commonly used for preventive treatment, as are some new injectables like Aimovig. Recently, doctors have even been using botox to treat migraines!

Migraine coverage with Medicare

Seniors who suffer from migraines might be wondering if their treatment will be covered by Medicare. The answer is sort of complicated: different parts of Medicare will cover certain migraine treatments, but only if your doctor confirms that you need it. For instance, Medicare Part B may cover injections, whereas Part D might cover prescription drugs.

What does Medicare Part B cover?

Part B can cover up to 80% of eligible expenses like doctor’s visits, labwork, or injections given by your physician. This means that after you meet your deductible, you will only have to pay 20% of the total cost. If you have a Medicare Supplement plan however, you may use it to cover that remaining coinsurance.

For more information on finding a Supplement plan to cover your medical expenses, use our Plan Finder tool or call 844-431-1832 to speak to a licensed agent today!

Does Medicare cover botox for migraines?

The FDA has approved the use of botox as a form of chronic migraine medication. It works by blocking certain chemicals that cause muscle pain. The primary botox injection sites for migraines are the muscle fibers in the forehead and neck, where migraine pain usually occurs. These injections are usually given every 10-12 weeks to remain effective.

In order for you to receive this coverage, your doctor may need to perform diagnostic tests to confirm to Medicare that migraine therapy is needed. Additionally, Medicare may require your physician to attempt other treatment options before it will cover botox injections. 

Be sure to check with your doctor to ensure that your botox injections will be covered by Medicare!

What does Medicare Part D cover?

Medicare Part D mostly covers prescription medications in the form of pills, ointments, inhalers etc. While many prescription migraine medications may be covered by your Part D benefits, it’s always better to be safe than sorry. Before getting your medication, check the formulary for your Part D plan and make sure that your prescription is covered.

We know that Part B will pay for injections administered by a medical professional, but there are some injectable migraine medications meant for home use. This is another area where Part D can help cover the cost!

Does Medicare cover Aimovig?

A new form of preventive medication has recently emerged, called calcitonin gene-related peptide (CGRP) antagonists. Name brands like Aimovig come in prefilled autoinjector pens and are usually prescribed on a monthly basis. 

Your Part D benefits may cover a prescription for Aimovig, but the actual amount you pay out-of-pocket can vary depending on if you’ve met your deductible. Don’t forget to check with your Part D plan provider to see if your Aimovig prescription will be covered and how much you will pay in coinsurance.

Treatments not covered by Medicare

There are many forms of alternative treatment for migraines that Medicare will not cover. Acupuncture has been suggested a way of treating migraines, as has massage therapy. Unfortunately, these methods have not been approved by the FDA and, as a general rule, Medicare will only cover FDA-approved treatments.

Chiropractic treatments have also been indicated as a method for natural migraine prevention and pain relief. Medicare however does not cover chiropractic care, except as part of subluxation correction.

If you are suffering from migraines, talk with your doctor about finding a form of migraine therapy that works for you and can be covered by your Medicare benefits!

Addison McNatt
Born and raised in Nashville, Addison graduated from Middle Tennessee State University with a major in History and a minor in Writing. After working in many different roles in healthcare and insurance, he has continued his passion for writing by penning blogs and the company newsletter here at Healthcare Holdings of America!