The bulging, dark veins that spiral down your legs often spark discomfort and self-consciousness. Despite being a common issue — affecting about 30% of U.S. adults during their lifetime, especially as they age — many still may find themselves hiding their legs beneath long pants out of embarrassment.
While varicose veins may seem like more of a cosmetic concern, they can signal more serious health issues. Yet, “it’s a simple fix,” says Dr. Christopher Yi, a board-certified vascular surgeon at Memorial Orange Coast Medical Center in Fountain Valley, California.
Fortunately, Medicare covers many treatment options for varicose veins when medically necessary, making it easier for eligible older adults to address issues early and prevent further complications down the line.
“It just needs to be acknowledged, noticed and addressed,” Yi adds.
Here’s what to know about varicose veins, treatment options and what’s covered under Medicare.
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What Are Varicose Veins?
Varicose veins are those large, twisting veins that bulge visibly from under the skin, often appearing in the lower legs.
“Varicose veins are a defect in the valves of the veins where the blood should be moving back to the heart,” explains Dr. Kuldeep Singh, associate chief of vascular surgery at Northwell Staten Island University Hospital in New York.
But when the valves fail, the blood stagnates or pools at the foot or calf level, he adds.
The pooling causes the veins to pop out, and as they do, components of the blood can leak out and deposit into the surrounding skin.
If left untreated, varicose veins can become a medical problem.
Varicose veins also tend to be more common in women than men and are more likely to appear during pregnancy or after age 50.
Varicose veins vs. spider veins
While often confused, varicose veins and spider veins are not the same. Spider veins are much smaller, lie flat under the skin and are primarily a harmless cosmetic concern. In contrast, varicose veins are larger, bulge from the skin and, as mentioned, can lead to medical issues.
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Symptoms of Varicose Veins
In addition to the visible large, bulging veins, symptoms of varicose veins may include:
— Aching pain
— Heaviness
— Fatigue
— Tiredness
— Itching
— Burning leg cramps
— Swelling
— Throbbing
— Ulcers, in severe cases
Generally, the longer you’re on your feet, the worse symptoms will feel, Singh says.
[READ: What Not to Say to People With Chronic Pain — and What to Say Instead]
Varicose Vein Treatment Options
Medical treatment for varicose veins — rather than cosmetic treatments to get rid of the physical appearance — is typically reserved for those who are symptomatic from the condition.
“Varicose veins themselves are not a medical problem,” Singh clarifies.
Unless it’s causing symptoms such as pain, heaviness in the legs or discoloration of ankles, then it’s more of a cosmetic concern.
Varicose vein management
Varicose vein treatment usually begins with conservative management. This step is often required by insurance providers to ensure all non-invasive options have been exhausted before considering a medical procedure.
Conservative measures for managing varicose veins include:
— Exercise
— Leg elevation
— Avoiding prolonged immobility
— Compression therapy
First and foremost, “we tell patients to try compression stockings — those stockings that go either up the knee or even to the thigh,” Singh says, adding, “You want to keep the blood circulating.”
Compression stockings work by promoting upward blood flow away from the foot and ankle, helping return it to the heart. Patients typically wear compression stockings as a daily ongoing therapy, putting them on in the morning and removing them at night.
Compression stockings won’t make the varicose veins disappear, Singh says, but they are effective at improving symptoms.
[READ The Most Common Signs of Poor Circulation and How to Improve Them]
Medical procedures for varicose veins
Medical procedures for varicose veins, collectively referred to as venous ablations, focus on closing or removing the affected veins to improve blood flow and reduce symptoms.
Common procedural options include:
— Laser ablation. This minimally invasive procedure uses a catheter with a laser at the tip. The laser generates heat, which damages the vein walls, causing the vein to collapse and close.
— Sclerotherapy. A chemical solution is injected into the vein, causing the vein wall to spasm and close up permanently.
— Radiofrequency ablation. RFA uses catheter-guided radiofrequency energy to heat the vein walls, which causes the veins to shrink and collapse.
— VenaSeal. This innovative procedure uses a medical-grade adhesive, or biologic glue, called VenaSeal, which is injected into the vein and closes it off, redirecting blood flow.
“They all do the same thing,” Yi points out. The procedures, he adds, simply use different mechanisms to close these veins with “severe reflux,” meaning the vein valves are not functioning properly, allowing blood to flow backward and pool.
“If done correctly, you see dramatic improvement in the symptoms of the legs,” Yi says.
Does Medicare Cover Varicose Vein Treatment?
Yes, Medicare may cover treatment for varicose veins if certain conditions are met. However, treatment for spider veins, which are considered cosmetic, is not covered.
To qualify for Medicare or other health insurance coverage, the criteria generally apply:
1. The procedure should be medically indicated. For Medicare to cover varicose vein treatment, your doctor must determine that the procedure is medically necessary. This involves evaluating whether the patient is experiencing one or more symptoms causing a significant medical issue, such as:
— Severe pain that impairs mobility
— Itching
— Ulcers
Additionally, the veins must meet size criteria.
“Those veins have to be measured a certain size based on an ultrasound,” Singh explains. “When a patient comes in, we do an ultrasound. We find out if there is some issue with the anatomy that’s causing the varicose veins.”
2. The patient has attempted conservative therapy.Patients are generally required to try conservative management approaches — most often, compression stockings — for at least three months before pursuing a medical procedure. The duration of this trial may vary depending on the insurance plan.
3. The patient can’t comply with compression therapy.
Alternatively, in some cases, the patient may be unable to use compression stockings.
Singh says there are a number of reasons why a patient may struggle with this.
“We’re not talking about regular socks. Those are very tight,” he says. “The overwhelming majority just can’t get those on.”
Common challenges include:
— Muscle weakness in older adults
— Limited mobility due back issues or obesity
— Increased pain with use
In such cases, Singh says that the doctor can submit a letter to the insurance provider explaining why the patient is unable to comply with compression therapy requirements.
Which Varicose Vein Treatments Does Medicare Cover?
Generally, Medicare may cover:
— Diagnostic ultrasounds or scans
— Laser ablation
— Sclerotherapy
— Radiofrequency ablation
— VenaSeal
Realistically, “a lot is dictated by insurance,” Yi says.
Depending on the patient and their individual circumstance, the insurer may approve a certain procedure and not another. Certain procedures also may require prior authorization.
How Much Does Varicose Vein Treatment Cost?
The cost of varicose vein treatment can vary widely, depending on the type of procedure, your insurance coverage, where you seek treatment and the complexity of your individual situation.
More specifically, costs can range from a few hundred dollars for compressions stockings and follow-up surveillance to several thousands for more invasive procedures. Sclerotherapy costs, for instance, generally range from around $1,400 to as high as $14,000. Laser ablation costs may range from $5,200 to $17,700 on average.
Medicare coverage for varicose vein treatment includes:
— Original Medicare out-of-pocket costs. Medicare Part B generally covers 80% of the approved cost for medically necessary varicose vein treatments, leaving the patient responsible for the remaining 20% after the deductible is met.
— Supplemental insurance. A Medigap plan may cover additional out-of-pocket costs that Medicare does not pay.
— Medicare Advantage plans. Depending on your Medicare Advantage insurance coverage, your plan may cover additional costs for medically necessary varicose vein treatment.
Expenses may include doctor’s office consultation fees and diagnostic tests like ultrasounds on top of procedural costs.
How to Prevent Varicose Veins
To help reduce the risk of varicose veins forming or to delay their development, you can:
— Stay physically active. Incorporating regular exercise, such as walking or biking, helps keep your blood circulating and strengthens your leg muscles, which may help your body pump blood back to the heart.
— Maintain a healthy weight. Having overweight or obesity is a major risk factor for developing varicose veins, as excess weight increases the pressure on your veins.
— Avoid prolonged sitting or standing. Both can lead to poor circulation. For example, people who are on their feet all day for work, like a hairdresser, may be at higher risk for developing varicose veins. Try to take breaks throughout the day to avoid the strain on your veins.
— Wear compression stockings. If you may be at higher risk for developing varicose veins, wearing compressions stockings can help improve blood flow in your legs.
Taking these proactive steps not only promotes healthy circulation and reduces pressure on your veins, but they also support your overall health.
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Does Medicare Cover Varicose Vein Treatment? originally appeared on usnews.com
