Does Medicare Cover Focused Ultrasound for Essential Tremor?

Focused ultrasound is a newer treatment that’s been generating buzz, especially for people living with essential tremor. If you or a loved one are considering this procedure, the big question is: Does Medicare cover focused ultrasound for essential tremor? Let’s dive deep into the details.

What Is Focused Ultrasound for Essential Tremor?

Focused ultrasound is a non-invasive treatment for essential tremor (ET), a neurological disorder that causes involuntary shaking, typically in the hands. It works by using sound waves to target and destroy the area of the brain responsible for the tremor.

Unlike traditional surgical procedures like deep brain stimulation (DBS), focused ultrasound doesn’t require incisions or implantation of any devices. Sounds like science fiction right? But it’s real and gaining popularity fast. The catch: it’s also pretty expensive. This brings us to the question that probably brought you here.

Does Medicare Cover Focused Ultrasound?

The Short Answer

Yes but only in certain cases. As of now Medicare does cover focused ultrasound for essential tremor but only if certain criteria are met. It’s covered under Medicare Part B, which generally covers outpatient services and medical procedures.

The Long(er) Answer

Medicare only covers focused ultrasound if it’s deemed medically necessary. This means that the treatment must be recommended by your doctor and must be for a condition that’s considered severe enough to need it. Essential tremor qualifies as one of those conditions in many cases but not all. It also requires that other less invasive treatments (like medication) haven’t worked for you.

The key here is that Medicare won’t cover it for everyone. You may have to jump through a few hoops to prove you’re eligible.

What Are the Costs with Medicare?

While Medicare covers focused ultrasound if deemed necessary, it doesn’t mean it’s free. Medicare Part B typically covers 80% of the cost of outpatient procedures, meaning you may be responsible for the remaining 20%. If you have Medicare Supplement Insurance (Medigap), it might cover those out-of-pocket costs.

Also, if you have a Medicare Advantage plan instead of original Medicare, coverage may vary based on your plan, and you’ll need to check with your provider.

Why Isn’t Focused Ultrasound More Widely Covered?

It’s not the fault of Medicare—okay, maybe just a little bit. Focused ultrasound is still relatively new in the world of medical treatments, and its long-term effectiveness and safety data are still being evaluated. Because of this, Medicare coverage policies can vary based on location and plan type.

“Focused ultrasound for essential tremor is a groundbreaking procedure but it’s still not considered first-line treatment for everyone,” says Henry Beltran, owner of Medicare Advisors Insurance Group LLC. “The tech is there but the cost and limited availability make it tough for Medicare to offer blanket coverage.”

Benefits of Focused Ultrasound

• Non-invasive: No cuts no incisions just sound waves.
• Minimal recovery time: Most patients are up and about the next day.
• Immediate results: Many patients see improvements in their tremor almost instantly.

That all sounds great right? It’s practically a miracle treatment. But wait there’s more (or less) depending on how you look at it.

Drawbacks of Focused Ultrasound

• It’s not reversible: Unlike DBS (deep brain stimulation), once the focused ultrasound has been done, it’s permanent. So if something goes wrong well you’re stuck with it.
• Expensive even with insurance: As mentioned Medicare covers 80% of the cost but with a price tag north of $20,000, that remaining 20% can still make a dent in your wallet.
• Limited to one side of the body: Focused ultrasound is typically done on only one side of the brain, which means it will treat tremor in only one hand. Yeah, say goodbye to your dreams of two-handed piano performances for now.
• Not a cure-all: Some patients don’t experience the level of tremor relief they were hoping for. So while it’s great for many it’s not a guaranteed fix for everyone.

How to Check If You Qualify for Medicare Coverage

To find out if Medicare will cover your focused ultrasound treatment you’ll need to follow a few steps:

1. Get a diagnosis of essential tremor from your doctor.
2. Try medication first. Medicare typically requires that other treatments (like medication) have failed before covering more drastic procedures.
3. If the medication doesn’t work, talk to your doctor about focused ultrasound.
4. Ask your provider to submit a prior authorization. Medicare may require this before covering the procedure.

Alternative Options for Treating Essential Tremor

Not feeling like rolling the dice on focused ultrasound or dealing with Medicare red tape? Here are some other options:

1. Deep Brain Stimulation (DBS)

This is the traditional option for essential tremor. It involves implanting electrodes into your brain to stimulate specific areas and reduce tremor. While it’s more invasive than focused ultrasound it can treat both sides of the body, and it’s reversible.

2. Medication

Common medications like propranolol and primidone are often the first line of treatment for essential tremor. They might not work as well for everyone but they’re a lot cheaper.

3. Lifestyle Changes

Believe it or not, sometimes reducing tremor is as simple as cutting back on caffeine and stress. No guarantees though—unless you’re willing to meditate for hours a day!

Henry Beltran’s Take

“Medicare can be tricky with newer treatments like focused ultrasound,” says Henry Beltran. “But at the end of the day it’s worth exploring all your options, especially if your essential tremor is really affecting your quality of life.”

Henry adds with a smile, “Just make sure you don’t try to take on Medicare alone. Trust me—it’s more complicated than a Rubik’s Cube at 2 a.m.”

Conclusion

While Medicare does cover focused ultrasound for essential tremor in some cases it’s important to know the eligibility requirements and potential costs involved. If you’re considering this treatment talk to your doctor and double-check with your Medicare plan to make sure you’re covered.

If focused ultrasound isn’t the right option for you don’t worry—there are other treatments out there that can help manage your tremor.

And remember if all else fails you can always give Henry a call at Medicare Advisors Insurance Group LLC for guidance. After all, navigating Medicare is like trying to follow GPS instructions that keep saying “Recalculating!”