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Medicare offers benefits for people with epilepsy

Does Medicare Cover Epilepsy?

Medicare offers benefits for people with epilepsy. Sometimes patients will need to meet a deductible before their coverage begins, and they may have a copayment or coinsurance for some services. Today, we’ll look at the general info and specifics of Medicare coverage for epilepsy patients.   

What Is Epilepsy?

Epilepsy is a chronic disorder where nerve cell activity in the brain is disrupted, causing seizures. There are different kinds of epilepsy and seizures, which may be caused by a genetic disease or a brain injury, like trauma or stroke. Unfortunately, the disorder afflicts people of all ages. Medications typically treat epilepsy, and sometimes surgery, devices, or dietary changes can help. 

Is Epilepsy Considered a Disability?

Being diagnosed with epilepsy doesn’t guarantee that you’re eligible for Medicare. You have to qualify for Social Security Disability insurance to get Medicare. The Social Security Administration examines how your condition impacts your ability to keep a job. They make a case-by-case decision. If you get disability benefits, you’ll qualify for Medicare two years after becoming eligible.   

Related Post: Medicare & Disability Waiting Periods: 3 Things to Know

An Overview of Medicare Coverage for Epilepsy

Medicare typically covers services and procedures that are medically necessary. It covers care for those with epilepsy, which includes:

  • Diagnostics 
  • Treatment 
  • Hospital care 
  • Medical care

Part A pays for inpatient surgeries. Outpatient doctor bills will fall under Part B. Also, doctors prescribe epilepsy drugs to control seizures, which are covered under Part D.   

Epilepsy patients need to get good healthcare, and treatment will be unique to the individual. 

Medicare’s Special Needs Program 

To be more specific, there’s a Medicare Advantage plan called a special needs program — meant for people with a chronic health condition. Special needs plans can also be an excellent option for epilepsy patients. They give people access to necessary medical care, like certain specialists and medications for their chronic condition. 

Related Post: 3 Types of Medicare SNPs You May Not Have Known About 

Medicare Part D Coverage for Epilepsy

While Part D covers prescriptions for many conditions, you should make sure your medications are included in the plan’s formulary. Epilepsy patients depend on pills to control epileptic seizures. Several antiepileptic drugs are available. Different folks respond to medicines in different ways, and the side effects may vary. 

Furthermore, anticonvulsants for epilepsy belong to six classes of drugs secured under Part D. All plans have to cover the medications in these protected classes.   

The low-income subsidy or the Extra Help program helps Medicare recipients gain access to lifesaving medications when there’s high cost-sharing involved. 

Medigap Coverage for Epilepsy

Because Medicare covers this seizure disorder, Medigap will cover it as well. However, if you’re under 65, it can be tough to get Medigap coverage. Some states have no Medicare Supplement plans for those under 65. In the states that do, it will cost more than Medigap for people who are over 65.

What Else You Should Know

-About one-third of those with epilepsy qualify for Medicaid.

-Medicare pays for deep brain stimulation for epilepsy, including essential tremor treatment. It involves surgically embedding electrodes in the brain.

Get Medicare Coverage Today

No matter your budget or medical needs, our Medicare agents can help you find the right plan. We’ll provide quotes, compare your plan options, and answer your questions. We are Trusted Senior Specialists. Give us a call at (855) 952-1941!