Does Medicare Cover Varicose Vein Treatment?

There is no one answer to the question of whether Medicare coverage includes varicose vein treatment. What does determine this is if they are causing health problems and/or creating a healthcare necessity.

Here’s what you need to know.

What Are the Different Types of Veins?

Let’s start with the basics. There are different types of impacted veins:

Bulging veins rise and protrude above the skin. They’re often found in your arms, hands, and face, but not all bulging veins are varicose.
Reticular veins are smaller than varicose veins. However, they don’t protrude above the skin the way that varicose veins do. Deoxygenated blood fills them causing discoloration of blue or purple, and they’re commonly found on the inner thigh and the backs of knees or ankles.
Spider veins are small clusters of fine veins and are typically considered to be a cosmetic concern.
Varicose veins are also called varicoses. They are twisted and enlarged and most common in your legs because standing and walking increases the pressure in your lower body veins. They are dark purple or blue and bulge, causing aching pain and discomfort.

Risk Factors for Varicose Veins

Several factors can increase the possibility that you’ll develop varicose veins:

Age. Aging causes wear and tear on the valves in your veins that help regulate blood flow.
Sex. Women are more likely to develop varicose veins. Hormonal changes before your period or during pregnancy or menopause can cause vein walls to relax. Hormone treatments, such as birth control pills, can increase the risk of varicose veins.
Pregnancy. During pregnancy, the volume of blood in your body increases and can lead to enlarged veins in your legs.
Family history. If other family members have had varicose veins, there's a greater chance you will too.
Obesity. Being overweight puts added pressure on your veins.
Standing or sitting for long periods.Blood doesn't flow as well if you're in the same position for long periods.

Medicare Guidelines for Varicose Vein Treatments

Your veins must be causing health issues for Medicare to pay the bill. You may have large and bulging varicose veins, but your doctor must deem the treatment medically necessary before Medicare will approve the treatments. A phlebologist will use an ultrasound to assess your veins and recommend the appropriate treatment plan.

To be approved the size of the veins must be 2. 5 mm or more. In most cases, Medicare will cover between 75% and 85% of the costs. The fee you pay will depend on the severity of your case and other variables.

These are the specific varicose vein treatment options that Medicare will cover. The most common of these include:

Sclerotherapy is often used for smaller varicose veins. It involves injecting a solution directly into the vein. This solution causes the vein to eventually disappear, forcing blood to reroute through healthier veins. The procedure is often done in your doctor’s office.
Endovenous laser ablation therapy is a procedure used to close off damaged varicose veins. This procedure is done inside the vein using heat to break down and close off damaged veins.
VenaSeal is medical-grade glue that’s placed inside a varicose vein using a tiny catheter. It seals the vein wall together in seconds. It is fast, minimally invasive and does not require post-treatment support stockings. Varithena foam can be injected into the veins through a small catheter. The foam irritates the lining of the varicose vein and causes it to close.
Varicose vein surgery is another option and can take place several ways, depending on the severity of symptoms. Vein stripping, ligation, laser, and ambulatory phlebectomies are among the most common types of surgery. Surgical stripping is performed in-hospital and involves a couple of days in the hospital, general anesthetic and a long, painful recovery time. Ambulatory phlebectomy is a much less invasive procedure compared to vein stripping and ligation.

Does Medicare Cover Venous Insufficiency?

Chronic venous insufficiency means your veins struggle to send blood from the legs to your heart. If left untreated, this may weaken the vein walls and damage your valves. Medicare covers venous insufficiency if lifestyle changes don’t help. This may include increasing exercise, using compression stockings, or taking medications.

Out-of-Pocket Costs

If Medicare covers your varicose vein treatment you may still have out-of-pocket expenses, including deductibles, coinsurance, and copayment costs. Costs you should expect to pay may include:

The Medicare Part B deductible, which is $233 per year in 2022.
After your Part B deductible is met, you are usually required to pay 20 percent of the Medicare-approved amount for most doctor’s services. There is no annual limit on how much you could pay for the Part B coinsurance each year.
If your varicose vein treatment requires inpatient care, you will need to meet your Part A deductible before your Part A hospital insurance coverage kicks in. In 2022, the Part A deductible is $1,556 per benefit period.

Do Medicare Advantage Plans Cover Varicose Vein Treatments?

Insurance companies offering Medicare Part C Advantage Plans must include all the benefits of Medicare. So, if Medicare covers your varicose vein treatment, an Advantage insurance plan will also cover the costs.

The important thing to remember is that Advantage plans often have a specific network of doctors and facilities you must use. Check your plan’s policies and find out what doctors and facilities are in-network to avoid costly out-of-network medical bills.

DISCLAIMER: Medi-Solutions Insurance Agency, LLC is not affiliated or endorsed with the Social Security Administration or the Federal Medicare Program. Information is for educational purposes only and should not be construed as an offer of insurance, advice, or recommendation. The information provided is not intended as tax, financial, investment, or legal advice. Please consult legal or tax professionals for specific information regarding your individual situation.