Nov 22, 2022 | Insurance & Medicare
Varicose veins are the larger, often bulging and twisting veins you often see on legs. They can be very painful or simply annoying.
If you’re wondering, will Medicare cover your varicose vein treatment, this blog post contains information you need to know.
What Causes Varicose Veins?
Veins are the blood vessels that carry blood back to the heart from the feet.
Varicose veins develop when the small valves inside the veins become damaged. When this occurs, blood no longer flows effortlessly through the veins. Instead, blood moves in two directions and may even pool in the veins.
This causes the veins to become stressed—they become larger and chronic venous insufficiency develops. The resulting varicose veins cause many uncomfortable symptoms, such as pain, swelling, and itching.
Varicose veins are more often found in women. But it’s not at all unusual for men to have varicose veins too.
If you are over 65 and on Medicare, you’re most likely covered for varicose vein treatment. This treatment will restore your veins to good health and put a stop to the annoying symptoms you endure daily.
Following is some information about Medicare that answers the question, “Will Medicare cover varicose vein treatment?”
Who Qualifies for Medicare?
Medicare is a very helpful, but initially confusing, insurance program.
Here are some basic helpful facts.
Medicare is a government-funded health insurance program for:
- People over 65
- People under 65 with specific disabilities
- People with permanent kidney failure that needs specific types of care
When Should You Sign Up for Medicare?
It’s advised that you sign up for Medicare 3 months before you are 65. This gives ample time to be included in the system.
If you were already eligible for Medicare but didn’t sign up, you can sign up during Medicare’s General Enrollment Period. This enrollment period lasts from January 1 to March 31 of each year. It’s starting soon!
There are also Special Enrollment Periods covering other specific situations.
The Different Parts of Medicare Explained
Part A covers inpatient hospitalization, skilled nursing facility care, hospice care, home health care, and more. They automatically enroll you in it if you are already receiving Social Security.
Part B covers doctors’ visits and services, outpatient care, many preventive services, and other services not covered by Part A. You must pay a premium with Part B, so you have the option of turning it down. You are not automatically enrolled. You must request it.
Part C (Medicare Advantage) plans allow private health insurance companies to cover the services that are usually covered under Medicare Part A and Part B. The coverage terms differ from regular Part A and Part B Medicare. Plan coverage will differ from plan to plan—and will not necessarily conform with Part A and Part B coverage terms. Learn about these plans to see if they work for you. If they do, contact the specific insurance company for enrollment.
Part D plans cover both brand-name prescription drugs and generic drugs. Plans will vary, and you should check out which plans offer the best payment for medicines you are already taking and may need in the future. Enroll by contacting the specific insurance company.
How to Sign Up for Medicare
If you haven’t already, create a Social Security account at ssa.gov/myaccount. Afterwards, you can sign up for Medicare online.
Or you can apply for Medicare at Social Security by calling 1-800-772-1213.
For more information about your current Medicare vein treatment coverage, call 1-800-MEDICARE (1-800-633-4227)
Will Medicare Cover Varicose Vein Treatment?
Medicare will cover varicose vein treatment if is determined that it’s a medical necessity. This usually goes for Medicare Part C Advantage Plans as well—but individual plans will vary.
So, what makes up a medical necessity with varicose veins?
A “medical necessity” is determined by a vein doctor.
Varicose vein problems will probably be called a “medical necessity” if:
- Vein related symptoms hurt your quality of life
- You experience common varicose vein symptoms such as pain, swelling, a feeling of heaviness, burning and/or cramping
- Ultrasound, or other imaging, diagnosed venous reflux
- There is bleeding from the veins
- You have related blood clots
- There is phlebitis in the veins
- You suffer with ulcers from veins
In most of these cases, patients must try conservative treatment for 6-12 weeks without good results. These treatments can include:
- Leg elevation
- Exercise
- Weight loss
- Ice/heat packs
- Compression stockings
Venous reflux also causes Spider veins, so they are often considered a medical necessity as well.
Which Vein Treatments Does Medicare Cover?
When deemed a medical necessity by your doctor, Medicare Part B will cover a range of varicose vein treatments at 80%. Usually your Medigap plan (additional insurance by a private company) will cover the rest.
Medicare Advantage plans need to be consulted separately.
Medicare covered vein treatments include:
- Sclerotherapy for varicose veins
- Micro sclerotherapy
- Endovenous ablation therapy
- Endoscopic vein surgery
- Laser vein surgery
Varithena is an injectable microfoam used with ultrasound-guided sclerotherapy for varicose vein treatments. Most patients find this varicose vein treatment nearly painless! Medicare usually covers vein treatment with Varithena when treatment is a medical necessity.
At New Jersey Varicose Vein Center (NJVVC), we offer state-of-the-art treatment for varicose veins, including treatment with Varithena.
If you want more information on insurance and varicose veins, you’ll find “Does Health Insurance Cover Varicose Vein Treatment?” helpful.
Visit Us at NJVVC for Your Vein Diagnosis
It’s easy to find out if Medicare considers your varicose vein treatment to be a “medical necessity.”
Simply visit us at the NJVVC and have an onsite evaluation and diagnosis performed solely by our doctor, Stuart Miller, MD.
Dr. Miller is an experienced and well-respected endovascular surgeon.
He trained in Internal Medicine at Rutgers/Robert Wood Johnson University Hospital and became a Diplomate of the American Board of Internal Medicine. Later, he completed a second residency in Radiology at Dartmouth. Afterwards he became a Diplomate of the American Board of Radiology.
Dr. Miller has been practicing in New Jersey for over 20 years, and now sees patients in Morris and Sussex counties.
Schedule your varicose vein consultation today at New Jersey Vein and Vascular Center to see if Medicare will cover your vein treatment. There’s no need to continue to suffer with varicose veins.
Oct 21, 2021 | Insurance & Medicare
Do you feel leg pain from varicose veins? Are you embarrassed to wear shorts or a bathing suit because of the varicose veins on your thighs? If so, treatment is available. But will your health insurance cover your varicose vein treatment?
Medical Necessity vs Cosmetic Appeal
Varicose veins can cause discomfort. This makes some people dread the thought of standing on their feet for a long time. Varicose veins can cause sores or ulcers to develop on legs and ankles. They can even promote development of blood clots. These veins are cause medical problems for the patient.
For others, varicose veins are more of a cosmetic embarrassment.
Are your varicose veins a threat to your good health, or are they simply unattractive? It’s important that you know the answer not only for your health but for medical insurance coverage as well.
• When varicose veins affect your health, treatment is a medical necessity. Medical insurance usually pays.
• Varicose veins are a cosmetic problem when they don’t threaten your health or well-being. Medical insurance won’t cover treatment.
To learn about your vein health, make an appointment to visit our office. Our highly skilled vein specialist will check your veins. He can develop an individualized treatment plan for you.
We even offer a free vascular screening. You have nothing to lose and so much to gain. You will feel better and enjoy improved vascular health.
How do Health Insurance Companies Define a “Medical Necessity?”
Let’s start with what we know. Medical insurance will cover treatment of varicose veins when it’s a medical necessity. But here’s the catch. What one company considers a medical necessity, the next company may not.
Visit our web page on Varicose Veins to learn more. There we discuss the symptoms and treatments of varicose veins. You will learn the specific symptoms that usually make treatment a medical necessity.
The criteria most insurance companies base their coverage approval on are:
1. Annoying or Painful Symptoms
2. Identified Venous Reflux— Insurance companies want proof that a vein is not functioning. Documented venous reflux, when blood flows backwards in a vein, is cause for treatment. We diagnose it with ultrasound. However, ultrasound cannot show venous reflux in spider veins; they are too small. So, medical insurance doesn’t cover the treatment of spider veins. They may make an exception for bleeding spider veins.
3. A specified Time of Unsuccessful Conservative Treatment— Did you try an improved diet and exercise plan? Did you wear compression socks daily? Did you rest and elevate your legs each day? The insurance company will want to know this information. Each insurance company has their own requirements. Some insurance companies want you to wear compression socks for 12 weeks.
The important takeaway here is that you need to learn what your insurance company covers. A friend’s experience with a different insurance policy can be quite different. This can be true even if they use the same medical insurance company.
Medicare, Medicare Advantage, and Supplemental Plan Coverage
Medicare offers great news for treatment—that is, when the veins are causing a health issue.
This Federal health insurance requires that treatment will protect or improve your health. They may want to know that you already tried lifestyle changes. But ultimately you can count on Medicare’s financial support.
Some common vein treatments that Medicare covers include:
• Sclerotherapy
• Ultrasound-Guided Sclerotherapy
• Laser Vein Ablation
Medicare will usually cover 80% of these costs. It is useful to have a good supplemental insurance plan to cover the remaining 20% of costs.
Be aware that Medicare Advantage will attach many stipulations to its coverage. Coverage from Medicare Advantage differs from coverage by Medicare.
Medicare and More Varicose Vein Treatments
Varicose vein removal coverage is less straightforward. There are many costs to consider, including:
• Doctor’s Fees
• Facility Cost
• Anesthesia
• Method of Extraction
• Number of Medical Sessions Needed
Do private health insurance companies, such Blue Cross Blue Shield (BCBS), United Healthcare (UHC) and Aetna, cover varicose vein treatments?
BCBS, UHC and Aetna are three major insurance companies that cover varicose vein treatments. But like Medicare, the companies only cover treatments of medical necessity. They won’t cover costs for a cosmetic procedure.
Each insurance company has its own criteria to meet. Once this occurs, they approve varicose vein treatment.
Contact your own insurance company to learn the specifics of your plan and policy.
Wonder if our office accepts your insurance? Then visit our website for a list of insurances we accept and to see if we are in network for your plan.
What about Varithena®, ClariVein®, and Endovenous Laser Ablation Treatment (EVLT)?
These are three of the outpatient treatments option that we provide for varicose veins.
Will your medical insurance provide coverage?
Varithena is an FDA-approved sclerotherapy medication. Our doctor injects it into the varicose vein to displace the blood and cause the vein to collapse. Medicare and most private insurance companies cover this non-surgical treatment. But again, it must be a medical necessary necessity. And insurance wants to see you first tried conservative treatment options.
ClariVein is a tiny rotating catheter used in non-thermal treatment of varicose veins. Some private insurance companies and Medicare cover vein treatment using the ClariVein catheter.
EVLT uses laser heat to treat varicose veins. We give the patient local anesthesia. Guided by ultrasound, the laser closes off the vein. Our patient’s health insurance usually covers this procedure. Again, insurance companies want to see that we tried other treatment options first.
Let’s not forget about compression socks and stockings
Patients often wear compression socks as a conservative first-line treatment for varicose veins. Patients also need to wear them after vein procedures or surgery. But Medicare does not pay for these socks—even if the doctor writes a prescription.
Medicare Advantage plans may provide some coverage for compression socks or stockings under certain circumstances. This helps since compression socks can cost more than $100 with certain prescriptions.
Are you ready to take the first step?
Does treatment for your varicose veins qualify as a medical necessity? For the answer, contact us for an appointment at New Jersey Varicose Vein Center. You will enjoy visiting our state-of-the-art vein treatment facility. And you will leave with a clear idea of the medical coverage you can expect.
