Epilepsy is a chronic condition that might make you eligible for Medicare before you turn 65 years old. Medicare coverage may include the tests your doctor needs for diagnosis, as well as medications and treatments like surgery.

Epilepsy causes you to have unpredictable seizures. It is managed with medications, devices, brain treatments, and surgeries.

You can get coverage for all of these care options using Medicare. It’ll also provide coverage for the tests that doctors use to diagnose epilepsy.

Read on to learn what Medicare coverage for epilepsy includes, when it applies, and which plans might be best for you.

You can get coverage for epilepsy through Medicare as long as you’re eligible for Medicare.

In some cases, you’ll already be eligible because you’re 65 years old or over. In other cases, your epilepsy diagnosis might make you eligible for Medicare regardless of your age.

That’s because Medicare covers people under age 65 years who have a disability and receive Social Security Disability Insurance (SSDI). An epilepsy diagnosis might qualify you to receive SSDI.

To start receiving disability benefits for epilepsy, you’ll need to apply for SSDI through Social Security.

The Social Security Administration will determine your eligibility on a case-by-case basis. This will depend on specific standards, such as being unable to work and earning less than $1,620 per month due to your condition.

Once you’re approved, there’s a 24-month waiting period before Medicare coverage begins.

Generally speaking, the following parts may provide coverage for epilepsy-related diagnosis and treatment:

  • Part A: Part A would cover hospital stays after a seizure and may also provide coverage for certain surgeries related to epilepsy when deemed medically necessary.
  • Part B: Part B should cover doctor’s visits and diagnostic procedures for people with epilepsy.
  • Part C: Medicare Advantage (Part C) is an alternative to Original Medicare (parts A and B) that offers the same benefits and, in some cases, additional ones. If it’s available in your area, you may opt for a Part C Special Needs Plan (SNP), which is specifically designed for neurological disorders like epilepsy.
  • Part D: This provides prescription drug coverage and is required to cover six classes of drugs, including anti-seizure drugs. Your Part D plan must cover at least two types of drugs in this category.

Keep in mind that, in most cases, Original Medicare (parts A and B) provides coverage for treatments when they’re deemed medically necessary. Medicare may not cover some experimental treatments or diagnostic procedures, so it’s a good idea to reach out to your plan to verify coverage.

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Managing epilepsy can be complicated and costly.

Overall, according to a 2022 study, the average spending on healthcare related to epilepsy and seizures between 2010 and 2018 was $24.5 billion.

A 2020 study also analyzed data from 2013 to 2018 to determine the cost of epilepsy-related medical visits for people with Medicaid, Medicare, and supplemental insurance.

According to the study, over 160,000 people required emergency transportation, and over 225,000 visited the emergency room. The average cost ranged from $57 to $22,305, depending on the type of visit and length of stay.

Costs can be affected by the type of procedure, treatment, or medications you get and where you’re treated. Depending on which insurance and what part of your plan covers your treatment, the out-of-pocket costs vary.

Generally, here’s what to expect in terms of cost per Medicare part:

  • Part A: Most people pay no premium for Part A. After you meet a deductible of $1,676 in 2025, Part A covers the first 60 days of hospitalization. Additional days in the hospital will incur a daily fee that increases with time.
  • Part B: This part charges a premium of $185 a month. Once you meet the $257 deductible, Part B should pay 80% of the cost of your treatment or procedure.
  • Part C and Medigap: Since private companies manage Medicare Advantage and Medigap plans, your costs will depend on your insurer and the specific plan. You can find available plans in your area on Medicare.gov.

Do I have to pay for epilepsy medication?

Your coverage of any epilepsy medications you need depends on your specific Part D plan and what tier your plan places the drug on its formulary (drug list).

In late 2024, the Centers for Medicare & Medicaid Services estimated the average 2025 premium for Part D plans to be $46.50.

Medicare Advantage (Part C) is an alternative to Original Medicare (parts A and B).

If you choose Part C, you get all the benefits of Original Medicare and sometimes additional benefits, depending on your plan. Some Part C plans include prescription drug coverage, which means you won’t need to purchase Part D.

That said, you have to choose between Original Medicare and Part C. You cannot have both.

Part C offers plans known as Special Needs Plans (SNPs). Specifically, you may benefit from a type of SNP called Chronic Condition Special Needs Plan (C-SNP), which can offer additional services, such as lower medication copays and specialty care coverage.

The availability of these plans depends on your location, and not all areas have C-SNPs for epilepsy. For this reason, you may want to use the Medicare website to verify if this is available where you live, what benefits it offers, and how much it costs.

It’s also a good idea to compare the cost of any drugs you need between Medicare Part D and a Part C plan with drug coverage in your area and confirm your doctor is in the network of any plan you’re interested in.

You can get coverage for epilepsy using Medicare. Epilepsy can also be a qualifying condition for SSDI and can make you eligible for Medicare before age 65 years.

Medicare will help cover the tests your doctor may use to diagnose epilepsy and the treatments you need to manage your condition.

It’s important to purchase a part of Medicare that includes prescription drug coverage since anticonvulsant medications are a primary treatment for epilepsy.