Does Medicare cover Irritable Bowel Syndrome?
Last Updated : 11/08/20194 min read
In the United States, there are between 25 and 45 million people who have irritable bowel syndrome, or IBS, according to the International Foundation for Functional Gastrointestinal Disorders, most of whom are women. If you have irritable bowel syndrome symptoms and are covered under Medicare, here’s what you should know about how Medicare pays for your IBS care.
What is irritable bowel syndrome (IBS)?
The Mayo Clinic defines irritable bowel syndrome (also known as IBS) as a chronic condition affecting the large intestine that causes cramping, abdominal pain, constipation, and diarrhea. Although the exact cause is unknown, IBS may be triggered or worsened by the following:
- Food allergies or food intolerance to things such as wheat, dairy, citrus, cabbage, and beans.
- Periods of increased stress.
- Hormonal changes, especially in women during and around the menstrual cycle.
Factors that may contribute to developing IBS include intestinal infections, abnormal muscle contractions in the intestine, and nervous system abnormalities in the digestive tract.
What are irritable bowel syndrome symptoms?
Irritable bowel syndrome presents differently in different individuals. Some people have bloating and gas which is partially relieved by a bowel movement, others experience diarrhea or constipation, and some have mucus in their stools. If you think you have irritable bowel syndrome symptoms, the Mayo Clinic recommends seeing a doctor if your IBS symptoms are accompanied by:
- Weight loss
- Rectal bleeding
- Anemia (iron deficiency)
- Bouts of diarrhea during the night
- Trouble swallowing
- Pain that doesn’t go away after a bowel movement
The Mayo Clinic also suggests that you are at increased risk for IBS if you are a woman (twice as many women as men develop IBS), are below the age of 50, or have a family history of the condition. Anxiety and depression may also be risk factors for IBS.
How is IBS diagnosed?
There is no definitive test to diagnose irritable bowel syndrome. The Mayo Clinic states that doctors generally use a combination of exams and tests to determine whether or not you have IBS or another digestive disorder including:
- physical examination
- diagnostic imaging studies such as colonoscopy or CT scan
- laboratory tests such as a stool test or lactose intolerance testing
How does Medicare cover the diagnosis and treatment of irritable bowel syndrome?
In general, Medicare covers all medically necessary tests ordered by your doctor to diagnose IBS. If you have Part B, Medicare generally pays 80% of allowable charges once you meet your Part B deductible. If you have Medicare Advantage, you may also have a copayment for these tests.
Treatment for irritable bowel syndrome generally focuses on reducing symptoms, according to the Mayo Clinic. Your doctor may ask you to change your diet to avoid foods that trigger the condition. You may also be given fiber supplements and laxatives to help manage diarrhea and constipation.
In some cases, your doctor may also recommend certain prescription medications specifically for people with IBS such as Lotronex or Viberzi. Some people also improve with antidepressant medications. In severe cases, your doctor may prescribe pain medications to relieve abdominal cramping.
In general, there is very limited coverage for prescription medications under Original Medicare (Part A and Part B). However, if you have a Medicare Part D Prescription Drug Plan, medications for irritable bowel syndrome may be covered. You can get Medicare Part D coverage through a stand-alone Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage.
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