What Are Medicare Benefits for Vertigo?

Medicare Benefits Solutions
Dec 3, 2021

For any number of reasons, there are times when you may feel dizzy, light-headed, and disoriented. Vertigo is a spinning sensation, which may feel like you are spinning or like the room is moving. According to the University of California San Francisco (UCSF) Health, “nearly 40% of U.S. adults experience vertigo at least once in their lifetime.” 

The most common cause of vertigo is benign paroxysmal positional vertigo (BPPV). The National Institutes of Health (NIH) defines BPPV as a “balance disorder that results in sudden onset of dizziness, spinning or vertigo when moving the head.” Other conditions that trigger vertigo include Meniere’s Disease and Labyrinthitis, both of which stem from inner ear disorders. 

Medicare benefits cover testing needed to pinpoint what precipitated your symptoms. The appropriate treatment may be covered under Medicare Part A, Medicare Part B, or your prescription drug plan, depending on your doctor’s conclusions. 

When to see your doctor

You should contact your doctor when you experience any sudden, severe, or prolonged dizziness or vertigo. Though BPPV may not be serious, this disorder occurs most frequently in adults 50 years of age and older, and symptoms can increase your risk of falling. 

BPPV symptoms may include a sense of: 

• Dizziness
• Spinning or surroundings in motion
• Unsteadiness
• Nausea

You should get emergency care if dizziness or vertigo are accompanied by:

• Headache that is unusual or severe
• Fever
• Changes in vision – vision loss or seeing double
• Loss of hearing
• Difficulty with speech
• Weakness in your limbs
• Loss of consciousness
• Walking difficulties or falling
• Tingling or numbness

Medicare Part B

Medicare Part B coverage includes medically necessary:

• Office visits
• Outpatient surgery (Inpatient surgery is covered under Part A.)
• Lab work, such as blood tests
• Tests like X-rays, MRIs, CT scans, and other diagnostic services

Because vertigo can be caused by trapped calcium deposits, fluid imbalance, or inflammation in the inner ear, your doctor will examine your ears for any irregularities. The office visit should also include checking your blood pressure, investigating if you have had any head injuries that may be related to your symptoms, and reviewing all medications you are taking.

Medicare Part D

Part D plans generally have a tiered formulary. This is your plan’s approved drug list, which typically includes generic, brand-name, and specialty drugs at different cost levels. Deductibles and coinsurance will vary from one Medicare plan to another.

Vertigo can be a side effect of some medications, especially for people taking multiple medications. In such cases, doctors may recommend alternate prescriptions. If your doctor prescribes a drug not included in the formulary, check your plan’s appeal process to see if your plan would consider approving an exception.