Does Medicare Cover Gastroesophageal Reflux Disease (GERD)?
Last Updated : 08/13/20184 min read
Gastroesophageal reflux disease, or GERD, affects about 20% of the population in the United States, the National Library of Medicine reported in 2013. Medicare may cover certain services related to GERD.
What is gastroesophageal reflux disease?
Gastroesophageal reflux disease (GERD) is a condition where stomach acid frequently backs up into your esophagus (the tube between your stomach and your throat), according to the Mayo Clinic.
Many people have heartburn sometimes, also called acid reflux (acid backing up into the esophagus), but GERD is the term for when the reflux happens again and again or is severe. The Mayo Clinic says when you have acid reflux a couple of times a week, or severe reflux once a week, it may be diagnosed as GERD.
There’s a muscle near the bottom of the esophagus, just above the stomach, according to the National Library of Medicine. This muscle relaxes when food comes down to enter the stomach. It’s supposed to tighten up again to close up the esophagus. But sometimes the muscle doesn’t close properly after you eat, and some of your stomach acid can leak up into the esophagus. It irritates the food tube and can make you feel heartburn. When this happens repeatedly, the esophageal lining can get inflamed.
What are the symptoms of gastroesophageal reflux disease?
The National Library of Medicine and the Mayo Clinic list the following symptoms. This may not be a complete list.
- Persistent cough
- A bitter taste in your mouth
- Asthma-like symptoms (such as coughing or chest pain)
- Difficulty swallowing or feeling like you have a “lump in your throat”
- Regurgitation of food or a sour-tasting liquid up into your mouth
Medicare and gastroesophageal reflux disease (GERD)
Medicare Part B (medical insurance) typically covers doctor visits and certain tests or screenings if your doctor accepts Medicare assignment. However, even if your doctor visits are covered by Medicare, you may need to pay a deductible and/or coinsurance.
Your doctor might be able to recommend lifestyle changes to manage your symptoms, notes the Mayo Clinic. She or he could recommend antacids, adds the National Library of Medicine (NLM). But severe GERD may require surgery. The type of surgery depends on your specific condition. For example, Science Daily notes that surgeons sometimes insert a magnetic esophageal ring through a minimally invasive surgery called laparoscopy.
Medicare Part A generally covers medically necessary surgeries. If your doctor discusses surgery or another GERD treatment with you, you may want to check with the doctor’s office, your Medicare health plan (if you have one), or Medicare for detailed information about Medicare coverage of GERD. You can reach Medicare at the number at the bottom of this page.
Medicare Advantage coverage and GERD
Since Medicare Advantage plans deliver your Medicare Part A and Part B coverage, you can expect a Medicare Advantage plan’s coverage of GERD to be like that of Medicare Part A and Part B. Again, you might want to call your plan ahead of treatment or surgery to be more clear about your how Medicare Advantage plan covers GERD.
Medicare Supplement coverage and GERD
If you’re enrolled in Original Medicare, Part A and Part B, you might want to learn about Medicare Supplement insurance. This insurance is designed to cover some of Original Medicare’s out-of-pocket costs, such as coinsurance and deductibles.
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