Does Medicare Cover Fibromyalgia?

Tamera Jackson by Tamera Jackson | Licensed since 2007
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This article was updated on: 09/12/2018

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Do you find that you have painful, tender places on your body? Are you tired almost all the time? It’s possible that you have fibromyalgia.

What is fibromyalgia?

Fibromyalgia is a health condition that may result in fatigue and pain all over your body, according to the National Institutes of Health.

What are the symptoms of fibromyalgia?

The National Institutes of Health (NIH) mention several symptoms; this is not a complete list.

  • Tender spots on your body where it’s painful when touched
  • Tiredness, even when you wake up
  • Tingling or numbness in your hands and feet
  • Moodiness (Mayo)
  • Trouble with your memory
  • Depression and anxiety (CDC)
  • Headaches

What causes fibromyalgia?

Researchers aren’t certain about what causes fibromyalgia, according to the NIH. It could result from repetitive injuries or physical or emotional trauma, for example. It could also be related to other illnesses, such as rheumatoid arthritis, reports the Centers for Disease Control.

What’s the treatment for fibromyalgia?

Your health-care provider might prescribe pain medication for you, according to the Centers for Disease Control (CDC). There are many other ways your provider might suggest to manage this condition. A few of these are listed below.

  • Exercise as directed by your health-care provider
  • Stress management techniques
  • Cognitive behavioral therapy, which can help bring about changes in how you feel and how you manage pain.

Please note that you should always talk with your doctor before trying these or any other ways to treat fibromyalgia.

Does Medicare cover fibromyalgia treatment?

If your doctor accepts Medicare assignment, Medicare Part B might cover doctor visits. You generally need to pay a coinsurance amount, and the Part B deductible applies.

Your health-care provider might prescribe pain medications or other prescription drugs. In general, Original Medicare (Part A and Part B) doesn’t cover prescription drugs in most situations. Medicare Part A (hospital insurance) generally covers medications given to you as a hospital inpatient as part of your fibromyalgia treatment. Medicare Part B may cover medications administered to you in an outpatient setting.

If you want to have Medicare coverage for prescription drugs, you may want to enroll in a Medicare Prescription Drug Plan. These plans are offered by private insurance companies that contract with Medicare. Every plan has its own formulary, or list of covered medications. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.

If you sign up for a Medicare Advantage plan, it might cover doctor visits and even prescription drugs for fibromyalgia. Medicare Advantage plans deliver your Medicare Part A and Part B benefits through a private, Medicare-approved insurance company (except hospice benefits, which Part A covers). Most Medicare Advantage plans also cover prescription drugs; but, as mentioned above, the medication would have to be in the plan’s formulary.  You need to keep paying your Medicare Part B premium, along with any premium the plan may charge.

If you have fibromyalgia, you might be wondering whether your Medicare coverage suits your needs. I can walk you through the Medicare plan options available in your area. If you have questions, I’d be happy to help.

  • To set an appointment to talk with me by phone, or have me email you customized information about Medicare plan options, you can follow the links below.
  • Do you want to check out Medicare plan options in your area at your convenience? Just click the Find Plans or Compare Plans buttons on this page.

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