Medicare Part B may cover Botox treatments if a doctor deems them necessary.
Botox is a drug that affects muscle contraction. It may be useful to help people with health problems such as chronic migraines, overactive bladders, and extreme underarm sweating.
This article discusses Botox and its cosmetic and medical uses. It also discusses Medicare coverage and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Botox can be used for cosmetic treatments and medical conditions.
Beauty therapists use tiny doses of Botox in cosmetic treatments to address the signs of aging, such as forehead lines and wrinkles. The FDA has approved Botox injections for use around the sides of a person’s eyes and in the middle of the forehead.
Doctors may use Botox to treat some medical conditions caused by muscle and nerve problems. These may include chronic migraine, an overactive bladder, eye problems, and certain muscle stiffness.
There are seven types of botulinum toxin, although only types A and B have medical or cosmetic uses. These toxins include:
- abobotulinumtoxin A (Dysport)
- incobotulinumtoxin A (Xeomin)
- onabotulinumtoxin A (Botox)
- prabotulinumtoxin A (Jeuveau)
- rimabotulinumtoxin B (Myobloc)
‘Botox’ is a registered trademark, although people frequently use the word to describe any botulinum toxin product.
Medicare is a government program that provides health care coverage to United States citizens. Beneficiaries are usually aged 65 and above, or younger if the person has certain illnesses or disabilities.
People can choose to receive their Medicare benefits either through original Medicare, which has Part A hospital coverage and Part B medical coverage, or through a bundled Medicare Advantage plan. Advantage plans include parts A and B coverage, plus other benefits such as prescription drug, dental, vision, and hearing coverage.
Most people do not pay a premium for Medicare Part A because they have paid enough Medicare taxes during their working life. For Medicare Part B, people must pay a monthly premium. In 2020, the standard premium is $144.60 per month.
Medicare beneficiaries also must pay out-of-pocket costs, including deductibles, coinsurance, and copays, for covered treatments and services.
Medicare will not cover the cost of Botox treatments for cosmetic purposes.
Generally, if the FDA has approved Botox for a particular medical treatment, Medicare covers the cost. If a doctor prescribes Botox for medically necessary reasons, it will be as done as an outpatient medical procedure and covered by original Medicare Part B.
FDA approval, and therefore Medicare coverage, includes the following procedures in adults:
- severe underarm sweating
- preventing migraines
- overactive bladder
- eyelid spasms
- cervical dystonia (a nerve disease that causes neck pain)
In addition, Botox is approved by the FDA for use in a child for upper limb spasticity (for a child older than two years) and crossed eyes (for a child older than 12 years).
A person considering Botox for their medical condition may want to talk with their doctor to find out if it is an effective treatment option.
The doctor may ask about a person’s medications, both prescription and non-prescription. Some prescription drugs cannot mix with a Botox treatment, or they could cause severe side effects.
The doctor will generally know if Medicare will cover the treatment costs. There are certain conditions associated with Medicare coverage.
A person must have sought help for their medical condition and had treatments without improvement before Medicare will consider covering Botox injections.
Defining the cost of a Botox treatment is challenging because the exact cost involved depends on several factors, including:
- Medicare plan
- medical condition
- number of injections
- size of the treatment area
- geographic location
Other costs may include anesthesia, surgery center fees, and prescription medicines, such as pain killers or numbing cream.
For example, according to the American Migraine Foundation, the FDA-recommended dosage of 155 units of Botox to treat chronic migraines would cost between $300 to $600 for each treatment.
The pharmaceutical company Allergan manufactures Botox, and offers a Botox Savings Card, so people can buy Botox at a reduced cost.
Botox is a toxin derived from bacteria. It can weaken or paralyze muscles and may block nerves.
Medicare does not cover the costs of Botox injections for cosmetic purposes.
If a doctor approves Botox to treat a medical condition, Medicare Part B may cover the procedure. Medicare covers FDA-approved Botox treatments, but the individual must have previously tried unsuccessful alternatives.
The exact cost of Botox treatments for medical conditions varies according to several factors, including the dose needed and where the person lives.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.