Although varicose vein development is closely linked to aging, vein conditions can affect anyone at any age.
As vein specialists in the Milwaukee, Wisconsin area, we’ve met many patients who are under the impression that varicose veins are merely a cosmetic concern. As a result, they have doubts on whether insurance will cover it or not.
The good news is that, in severe cases, health insurance does cover varicose vein treatment!
In this article, we’ll discuss how Medicare and other insurance plans approach varicose vein care, the variety of available treatments, and how to navigate insurance coverage to make sure you receive the medical attention you need.
Understanding Varicose Veins and their Impact
If you notice that your veins are becoming swollen and visible, you might be developing what we call ‘varicose veins.’
For context, varicose veins are bulging, swollen, discolored veins, which are typically visible under the skin.
It’s important to note that not all visible veins are the same, and the distinction between varicose and other veins can play a big role on whether or not vein treatment is covered.
For example, you might notice the development of delicate, web-like veins under your skin. These are commonly called spider veins, and they are smaller cousins of varicose veins. Spider veins can hint at underlying health issues — but a doctor or other medical professional may also decide that they are solely a cosmetic concern. If they decide the issue is cosmetic, an insurer is less likely to cover their treatment.
All this said, varicose veins can easily move from ‘cosmetic concern’ to ‘medical concern.’ If left untreated, varicose veins can lead to complications and painful symptoms such as bleeding, fatigue, skin discoloration, swelling, and aching. These are signs of an underlying condition called chronic venous insufficiency.
Does Medicare Cover Treatment for Varicose Veins?
Yes, Medicare does cover the medical treatment of varicose veins. However, there are some stipulations.
First, varicose vein treatment is only covered for veins that cause symptoms and have ultrasound characteristics of chronic venous insufficiency. Second, a physician’s office visit and diagnostic ultrasound are needed to determine the medical necessity of vein treatments before the procedure is approved.
You might find that your doctor will first encourage you to try alternative treatment options for varicose veins instead of vein treatments. These can include exercise, weight loss, and medical-grade compression stockings.
If you follow through with at-home treatments recommended by your physician, but the symptoms persist and become more severe, the likelihood that Medicare will cover the cost of treatment increases dramatically.
Medicare Guidelines
Varicose vein treatments covered by Medicare are performed in an outpatient setting and can include phlebectomy, sclerotherapy, laser ablation, foam sclerotherapy, and vein stripping.
Each of these treatments serves a different purpose and can be utilized by a vein specialist depending on the severity and location of the varicose veins.
Before Medicare approves any treatments or procedures, your doctor must consider treatment medically necessary. After you get that approval, if your outpatient vein procedure qualifies for Medicare coverage, you must meet your Part B deductible in order to benefit from the coverage.
Provided the deductible is met, Medicare will pay 80% of all procedure-related charges. This implies that, on average, patients will still have to cover the remaining 20% unless they have supplementary insurance, such as Medigap, which can fill in these coverage gaps.
Untreated varicose veins can lead to severe complications, which can require hospitalization for treatment. In this case, Medicare Part A will pay for inpatient care, and Part A deductibles will apply.
Medicare Advantage and Its Role
For those with Medicare Advantage plans, it’s important to understand there are many nuances that can impact where, and whether, your varicose vein treatment is covered.
While these plans must offer all benefits of standard Medicare, they often have specific networks of healthcare providers that one must utilize to be covered. Going outside of this network might incur additional costs. Also, unlike traditional Medicare, the out-of-pocket costs associated with Medicare Advantage can vary, which in turn can make expenses unpredictable.
If you have Medicare Advantage and aren’t sure about coverage, reach out to your vein treatment center to discuss the issue.
Medication and Additional Treatments
There is no specific medication approved for the treatment of varicose veins. However, your doctor may help you manage symptoms before and after treatment by prescribing medication.
These medications, often aimed at alleviating symptoms or preventing complications, may be covered under Medicare Part D. Always check your plan’s formulary to ensure the prescribed medicine is included. If it’s not, you might need to ask your doctor for an alternative or be prepared for out-of-pocket expenses.
Additionally, venous insufficiency, where veins struggle to send blood from the legs back to the heart, can be a complication. Without treatment, this may weaken the vein walls and damage your valves. Medicare does provide coverage for this issue if preliminary lifestyle changes don’t bring about improvement, so if this is one of your areas of concern, be sure to consult your doctor or vein specialist to ensure you receive the proper care and coverage.
Securing Health Insurance Coverage for Varicose Vein Treatments
If you’re not on Medicare, there are still ways for your insurance plan to cover vein treatment.
To start, holding an active medical insurance policy that covers varicose vein treatments is crucial. This step ensures you’re positioned to receive the necessary coverage.
Next, as we’ve mentioned above, you must demonstrate the medical necessity of treating your varicose veins. This often involves documentation highlighting the traditional at-home treatments you’ve tried, such as leg elevation, physical exercises, or lifestyle changes. A notable part of this documentation will likely reference undergoing compression therapy, where the patient uses compression socks or stockings.
Just like any other doctor, you must be mindful of your vein specialist’s association with your insurance company. Ensure your doctor or vein specialist is an ‘in-network provider.’ This makes for seamless payment from the insurance company after the procedure is completed, and suggests that your doctor’s office would be well-versed with the necessary protocols to get treatments covered.
Once the groundwork is laid, your vein specialist will evaluate and decide which treatment option will be the most effective for you and your condition.
After pinpointing the treatment, you must notify your insurance company about your intention to undergo varicose vein treatment and detail the recommended procedures. This is also a good time to understand all the nuances of your policy, from co-pays to any applicable deductibles.
Lastly, remember that organization can be your ally. Gather and present all related medical documents, and remember that having your documents readily accessible can streamline this process.
If you follow these steps, you’re ensuring that you’ll be on a clear path to receiving the care you need.
Insurance and Payment Options at our Clinic
Our clinic in the Wisconsin, Milwaukee area does accept Medicare and most southeast Wisconsin insurance payers, many of which are considered “in-network.”
Most office-based vein treatments, such as endovenous ablation or ultrasound-guided sclerotherapy, are also covered by medical insurance if proven to meet medical necessity.
If you do not see your insurance provider listed on our website, get in touch with us for more information. We can clarify your insurer — or, if you’re not covered, provide a comprehensive estimate for out-of-network patients so that you understand your financial commitment.
For more information on Medicare eligibility, click here. And if you’re curious about learning more about vein treatment, feel free to contact us to schedule a consultation.
