June 4th 2024
By Ari Parker
Both Original Medicare and Medicare Advantage cover visits to the neurologist, but your out-of-pocket costs will be different. Read more about coverage here.
As you age and experience different health conditions, you may need to see providers that specialize in a certain area of medicine, like neurology. A neurologist helps diagnose and treat conditions related to the nervous system.
Original Medicare provides coverage for 98% of doctors, including specialists. You’ll simply be responsible for your deductible and coinsurance. If you have a Medicare Advantage plan, you’ll receive full coverage only if you see an in-network neurologist. With full coverage you’ll be responsible for your deductible and a copay or coinsurance.
Medicare covers neurologists. With Original Medicare, you’ll pay 20% of the cost of a visit to the neurologist. Enrolling in a Medicare Supplement plan can help reduce or eliminate your coinsurance.
Medicare Advantage plans also cover neurologists, but your out-of-pocket costs are different. You’ll typically pay a copay or a coinsurance to see a specialist, which can be higher if the neurologist is out of network.
Neurology deals with anything related to the nervous system, which is made up of your brain, spinal cord, and nerves. There are many neurological conditions that require a neurologist. The most common ones include:
Strokes and seizures
Neurodegenerative conditions like Alzheimer’s, Parkinson’s, and amyotrophic lateral sclerosis (ALS)
Autoimmune disorders
Conditions relating to the nerves, like diabetic neuropathy
Infections like meningitis that affect the nervous system
Neurologists specialize in neurology. They use various techniques to diagnose and treat conditions affecting your nervous system. These healthcare professionals can order MRIs, CT scans, spinal taps, and other tests to check for the cause of your neurological symptoms. Neurologists can recommend a variety of treatments based on your diagnosis. Common treatments for neurological conditions include:
Medications to reduce inflammation, control muscle spasms, and treat neuropathic pain
Speech language pathology
Neurosurgery
Counseling
Medicare has broad coverage for doctors of all kinds, including neurologists. If you have Original Medicare and your neurologist accepts Medicare (98% of healthcare providers do) you’ll pay 20% of the cost of the visit. You’ll also pay this coinsurance for any services they recommend. A Medicare Supplement plan can help reduce your out-of-pocket costs. If you have a Medicare Advantage plan, we explain the details of how coverage works below.
Certain neurological conditions may need extra support from other specialists. Below are some other healthcare specialists that Medicare covers if you need services from them:
Clinical psychologists
Clinical social workers
Therapists and mental health counselors
Clinical nurse specialists
Nurse practitioners
Occupational therapists
Physician assistants
Physical therapists
Speech-language pathologists
Neurologists are covered under Medicare Advantage plans, but you’ll need to see an in-network neurologist to receive full coverage. This is because Medicare Advantage uses provider networks. Medicare Advantage plans also have different out-of-pocket cost structures. You’ll generally owe a copay for visits with specialists. Your copay and any coinsurance owed will vary from one Medicare Advantage plan to another. Furthermore, the cost of a neurologist visit and necessary tests and treatments can be higher if you see an out-of-network doctor.
Finally, you’ll also have to consider the cost of any services they recommend. What you pay for coinsurance for these services depends on your specific Medicare Advantage plan.
Insurance coverage and costs are confusing! And with Medicare, things are complicated by the different coverage options available (Original Medicare vs. Medicare Advantage) as well as the variance between different plans. If you need to see a neurologist, you should understand your coverage and make sure it will save you the most on your healthcare costs. Talk to a Medicare agent at Chapter who can help you understand your current Medicare coverage and switch to a better suited plan, if applicable. Call us at 855-900-2427 or schedule a time to chat to get help.
