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Migraines: A health insurance headache for millions of Americans

As many as 36 million Americans suffer from migraine headaches, according to the Migraine Research Foundation. In many cases, frequent migraines can lead to depression, anxiety, sleeplessness and other disorders.

Not only are migraines painful, they're expensive. Migraines cost the United States more than $20 billion each year, according to the American Headache Society. Those expenses include doctor's visits, medication, missed work and lost productivity.

Given the expensive consequences of migraines, it's important that those who need treatment get it. But while health insurance generally covers medicine and treatment, barriers and limitations may pop up.

migraine health insurance

What migraines cost patients

Migraine treatment can include acute or abortive medicines. Abortive treatments are designed to stop symptoms as they're happening. Acute drugs, meanwhile, can be taken regularly to reduce the frequency or severity of recurrent migraines. The drugs can come in the form of pills, nasal sprays and injections.

Triptans, a group of abortive medications, range from about $12 per tablet to $50 per injection. Because of the relatively high cost of the pills, and the fact that many insurance companies limit the number of pills per month, some migraine sufferers put off using the medicine rather than taking it at the start of an attack, when it's most effective.

"Patients sometimes get into destructive behavior," says Michael John Coleman, executive director of the Migraine Awareness Group: A National Understanding for Migraineurs (MAGNUM). "They hesitate to use their expensive medication."

Patients are advised to research medical guidelines and to follow up with their health insurers regarding migraine treatment and coverage.

A question of coverage

Susan Pisano, vice president of the trade group America's Health Insurance Plans, says treatment of migraines with drugs typically is covered by health insurance. However, most insurance companies limit the number of doses per month. As a supplement to medication, some insurance companies offer migraine management programs, Pisano says.

Highmark Blue Cross Blue Shield, for example, offers an online lifestyle improvement program just for migraine sufferers. Registered nurses and lifestyle specialists are available through a toll-free number to help members manage migraines.

In cases where patients are experiencing at least three migraines a month, with each episode lasting up to three days, the condition could be deemed "disruptive" and might qualify for disability insurance.

While migraines may be considered a pre-existing condition, that's generally not a coverage issue when moving from one employer's group health insurance plan to another. However, if you're seeking coverage in the individual health insurance market, migraines may be deemed pre-existing conditions and, therefore, won't be covered. In 2014, the federal health care reform law will prohibit health insurers from denying coverage of pre-existing conditions.

Alternative treatments and coverage

Alternative and experimental migraine treatments aren't widely covered by health insurance. Biofeedback is a method that teaches muscle relaxation and encourages lifestyle changes to reduce stress levels. Generally, six to seven sessions -- at a cost of about $75 per session -- are needed for the patient to learn the technique.

Botox has been approved by the U.S. Food and Drug Administration (FDA) for migraine treatment, and it's sometimes prescribed for people who suffer from frequent migraines. However, patients would have to meet their health insurers' strict requirements for a Botox treatment to be covered. For some, surgery might be another option. The procedure involves cutting the nerves in the patient's trigger areas, including brows, temples, behind the eyes and at the back of the head.

No insurance?

Migraine sufferers who lack private health insurance are twice as likely to get inadequate treatment for their condition as their insured counterparts, according to a study published in April 2010 in Neurology, the medical journal of the American Academy of Neurology. Medicaid recipients were 50 percent more likely to receive below-par treatment, suggesting that access to some types of insurance is not the same as access to adequate care, researchers said.

People without private insurance and people on Medicaid were more likely to receive migraine care in an emergency department than in a doctor's office, which helps explain the substandard care, according to the study.

"The tragedy is that we know how to treat this disabling condition. But because they are uninsured or inadequately insured, millions of Americans suffer needlessly," study author Dr. Rachel Nardin, a Massachusetts neurologist, said when the study was released.

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