Does Medicare Cover Botox for Migraines?

In this article...
  • Does Medicare cover Botox for migraines? If you've tried other treatment options and are still experiencing migraines, you may be covered by Medicare for Botox.

Does Medicare cover Botox for migraines? While Botox is not covered for cosmetic use, the FDA has approved its use for the treatment of numerous medical conditions, including migraines. For this reason, Medicare will cover Botox as long as you can provide documentation that it's required for a specific medical condition. You may also need to show that other treatments have been unsuccessful in the past and that your doctor feels it's the only viable treatment option.  

If you’re enrolled in a Medicare Advantage plan, you may not have access to a prescription drug plan, as Advantage plans are not required to cover your medications. In this instance, you may be able to receive Botox under the provision of outpatient care, since you will be required to receive your injection under the supervision of your doctor. 

What Migraine Medication Does Medicare Cover? 

There are different Medicare Part D plans that provide various levels of coverage, but most migraine medications are covered in one form or another. Instead of getting a brand-name drug, you may need to settle for a generic version. Many times, doctors must attempt to treat you with a prescription medication before attempting to use Botox. Medicare will usually only provide authorization for Botox once you’ve exhausted other options. The good news is that most of the medications your doctor may suggest for treatment are covered.  

How Do I Get Approval for Botox Treatments for Migraines? 

Most Advantage plans will require you to attempt treatment with at least two medications before approving Botox treatments. This is also true of traditional Medicare. If you’re suffering from migraines, you should follow the advice of your doctor, who will monitor your progress through different prescription medication options. Once at least two have failed, your doctor might seek approval from Medicare to treat you with Botox. 

Even if Medicare rejects your first attempt at authorization, you’ll be able to appeal the decision. Make sure that your doctor presents all of the information needed to justify your need for Botox treatments, including your medical history and prior attempts to treat you. If you’re enrolled in an Advantage plan, you can work with your insurance provider to gain the needed approval and your doctor might file most of the paperwork on your behalf. 

Does Medicare Part B Cover Botox for Migraines? 

Another way for you to receive coverage for Botox treatments may be to have them administered in your doctor’s office. If Botox is not listed in your Medicare Advantage plan’s drug plan formulary or you don’t have drug coverage, you can arrange to receive the treatments at your doctor’s office. Since Advantage plans are required to cover everything provided through Medicare Part B, this is a valid way to receive coverage. 

Whether you’re billing your Advantage plan or Medicare Part B, you do need to show that there is a medical need for the treatments. You also need to meet your deductible for the year and then pay for 20% of what your treatments cost.