Does Insurance Cover Botox?
Health insurance and Medicare usually cover Botox for certain medical conditions.
Your plan will probably cover Botox for chronic migraines, overactive bladder, severe sweating, and certain types of muscle spasms and stiffness. But insurance won't cover Botox for cosmetic reasons, such as filling in wrinkles. And you might not have coverage for certain medical conditions that Botox isn't approved to treat, like TMJ.
Will insurance cover Botox?
Find Cheap Health Insurance Quotes in Your Area
Is Botox covered by insurance?
Your health insurance probably covers Botox if you need it for medical reasons.
Botox is approved to treat certain health issues, including chronic migraines, specific types of muscle stiffness, and severe underarm sweating. Your health insurance is more likely to cover Botox for these conditions than other health issues. And Botox is never covered for cosmetic reasons.
You may need to show proof that other treatments didn't work before your health insurance will pay for Botox.
You'll probably still have to pay for some of your treatment in the form of a deductible, copay or coinsurance. The amount you have to pay will be different depending on your health insurance plan. If you aren't sure what you'll pay, talk to your health insurance company.
Will insurance cover Botox for TMJ?
Your health insurance might cover Botox for TMJ, but it depends on your plan.
The best way to find out if your plan has coverage is to talk to your health insurance company.
Botox is not approved by the Food and Drug Administration (FDA) for TMJ disorders. Some doctors still prescribe Botox for TMJ, even though it isn't approved. This is called off-label use.
But some health insurance plans cover off-label use of medications in certain situations. And some states have laws about the off-label use of medications. If you and your doctor think Botox could be helpful for your TMJ, talk to your insurance company to see if you have coverage.
Will insurance cover Botox for migraines?
If your migraines are chronic, your health insurance will probably cover Botox.
You might have to prove that other treatments didn't work or get prior approval before your plan will pay. And you will still likely have to pay for part of your treatment in the form of coinsurance or a copay for your office visit.
Does insurance cover Botox for wrinkles?
Health insurance won't pay for cosmetic Botox.
If you get Botox to smooth wrinkles, you will pay the full cost yourself.
Health insurance only pays for things that you need to improve or maintain your health. Because wrinkles don't actually harm you, smoothing them with Botox isn't something health insurance will pay for.
How much does Botox cost with insurance?
Botox usually costs up to $163 if you have insurance.
Most of that cost is from the deductible, coinsurance and copay. The amount you pay for Botox will vary because each insurance plan has its own rules and limits.
Botox Savings Program
Botox has a program that can help pay for the costs your health insurance doesn't cover. If you qualify for the Botox Savings Program, you might not have to pay anything for your treatment.
You have to meet five eligibility requirements to qualify for the Botox Savings Program.
- You have to currently be getting Botox for an approved condition.
- You have to have health insurance from your employer or a private health insurance company.
- You aren't eligible for or enrolled in Medicare, Medicaid, or any other federal or state health care program.
- You're 18 or older, or the parent of someone under 18 getting Botox.
- You're getting your Botox treatment in the U.S. or its territories.
Does Medicare cover Botox?
Medicare only covers Botox for medical reasons.
Your doctor will have to provide Medicare with info about why you need Botox, what other treatments haven't worked, the dosage of Botox you need and where you need it. Medicare only covers for one injection per body part, even if you need more than one injection.
Medicare won't cover Botox for wrinkles or other cosmetic reasons.
How much does Botox cost with Medicare?
According to Botox, treatment costs between $33 and $196 if you have Medicare.
The cost changes depending on why you need Botox treatment. For example, if you have an overactive bladder, Botox costs about $33 per month if you have Medicare. But if you need Botox for chronic migraines, you'll pay an average of $196 for a 12-week treatment if you're on Medicare.
If you're on Medicare, you do not qualify for the Botox Savings Program.
Botox is covered under Medicare Part B, which usually pays for about 80% of your medical care. You pay the remaining 20%.
Frequently asked questions
What are the medical reasons for Botox?
Botox is FDA-approved to treat chronic migraines, certain types of muscle stiffness and alignment issues, overactive bladder and excessive underarm sweating. Some doctors might also prescribe Botox for TMJ, although that use isn't approved by the FDA.
Will insurance cover masseter Botox for TMJ?
Insurance might cover masseter Botox, which means it's injected into your jaw muscle, but it depends on your plan. Botox isn't FDA-approved for TMJ, but if your doctor says it's medically necessary, your plan might still cover it. If you're concerned about the price, talk to your health insurance company before you get treatment.
How much should I expect to spend on Botox?
You might not pay anything for Botox if you qualify for the Botox Savings Program. Otherwise, you can expect to pay up to $196 per 12-week treatment, depending on what kind of insurance you have. If you don't have insurance, you'll have to pay the full cost yourself.
Sources
Info about Botox, insurance coverage and costs come from Botox and the Centers for Medicare and Medicaid Services (CMS).
Editorial note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.