How to Get a Wig Covered by Insurance or Medicare

If you’ve experienced hair loss resulting from cancer treatment, alopecia, or another medical condition like trichotillomania, a wig can help to boost your confidence, make you feel more like yourself, and protect your sensitive scalp. A high-quality wig can be a significant expense, but your health insurance or Medicare may cover the cost of a medically necessary wig. Navigating the complex insurance process can be a big challenge—especially when you’re facing a life-changing condition like cancer—so we’re here to outline the essential steps for getting your wig covered. We’ll also answer some common questions about insurance coverage for wigs.

Step-by-Step Guide: Getting a Wig through Insurance or Medicare

1. Understand the Terminology:
   • In the insurance world, a wig needed for medical reasons is known as a “cranial prosthesis.” Using this term can help you obtain coverage for your wig purchase, since some insurers classify a “wig” as a cosmetic item. Your insurance company may also use terms such as: hair prosthesis, cranial hair prosthesis, full cranial prosthesis, or extra-cranial prosthesis.
2. Contact Your Insurance Company:
   • To start the process of getting your wig, reach out to your insurance provider or a Medicare representative. Policies about wig coverage vary by provider (and Medicare can be especially tricky—see our FAQ below for more), so your insurance company will be able to give the most accurate information about the steps you’ll need to take. Be sure to ask about the following:
3. Does your policy cover a cranial prosthesis? If so, which types are covered (synthetic wigs, human hair wigs, etc.)?
   • How much of the cost is covered?
   • What types of documentation are needed to submit your claim? (You may need to provide a prescription, medical necessity statement using the required terminology, a Cranial Prosthesis Form that serves as your proof of purchase for reimbursement, etc.)
4. Obtain an ICD-9 Code from Your Doctor:
   • An ICD-9 code is a standardized code that identifies your specific diagnosis; doctors and insurance companies both use this system of codes to communicate about medical conditions. Your insurance company will review your ICD-9 code as part of your documentation to determine if you qualify for cranial prosthesis coverage.
5. Get a Prescription:
   • Next, work with your doctor to get a prescription for your cranial prosthesis. The prescription should document medical necessity and include the specific terminology requested by your insurance company, as well as a medical procedure number or code that you’ll use to submit your insurance claim.
6. Purchase Your Wig:
   • After you’ve gathered all the necessary documentation, you’re ready to purchase your wig. In most cases, you’ll need to pay for your wig out-of-pocket then file a reimbursement claim with your insurance provider.
   • At Headcovers, we’ll provide you with an appropriately worded Cranial Prosthesis Form, which includes the information your insurance company needs. You’ll submit that form, along with your prescription, a completed insurance claim form, and any other requested documentation, to your insurance company. Once your claim is successfully processed, you’ll be reimbursed for all or part of your wig’s cost.

Insurance Coverage for Wigs: Frequently Asked Questions

Does insurance cover the purchase of a wig?

Insurance companies usually won’t pay for a wig directly, but most will reimburse you if your condition qualifies and you follow the steps outlined above. At Headcovers, we’ve successfully worked with all major insurance providers to reimburse customers for cranial prosthetics.

Does Medicare cover the purchase of a wig?

Getting a cranial prosthetic covered through Medicare can be more challenging, since wigs are not covered by basic Medicare plans. However, if you have a Medicare Advantage Part C plan or another type of supplemental coverage, you may be able to get reimbursed. Reach out to a Medicare representative to understand what your policy provides.

How much of my wig cost will insurance cover?

Most insurance companies will cover 80-100% of a cranial prosthetic’s cost.

What if insurance or Medicare won’t cover my wig?

While most insurance companies will pay for a cranial prosthesis if you followed the steps above, there are exceptions. If wigs are not covered under your insurance policy, your first option is to contact your employer’s HR department or your insurance broker and try to renegotiate your contract to add coverage.

If you’re not able to negotiate with your insurance provider, an out-of-pocket wig purchase may be a tax-deductible expense if your medical bills are more than 7.5% of your income. Be sure to save receipts and any other documentation of your purchase, then work with a tax professional to receive the deduction.

Finally, there are resources for individuals who need help covering the cost of a wig. The American Cancer Society, National Alopecia Areata Foundation, and other national and local nonprofits offer financial assistance. Your doctor or a social worker in your area may be able to recommend an organization that fits your needs.

How many wigs will my insurance cover?

Most insurance companies cover the cost of one cranial prosthesis per year. You’ll have to pay for additional wigs out-of-pocket. For those with permanent or longer-lasting hair loss, proper care will help you build and maintain a collection of wigs that lasts for years. Take a peek at our resource guide for all you need to know.

For greater variety in head coverage options, you may also want to consider purchasing an array of hats, scarves, and sleep caps. These are generally more affordable than wigs and can provide you with comfortable solutions for relaxing at home, sleeping, or going out in the sun.

Do you have any tips for purchasing a wig?

Once you’re ready for your purchase, take a peek at our Wig Buying Guide to make the process as easy as possible. We also offer wig consultations with our expert stylists, who can help to guide you through our full wig collection with thousands of comfortable, natural-looking options.

Have additional questions about navigating the insurance process as you purchase a wig? We’re here to help! Our dedicated team is committed to providing personalized, compassionate, and informed service every step of the way. Contact us via chat, phone, or email for prompt answers to all your questions.