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Learn About Medicare Coverage for Arthritis Treatment

Arthritis affects almost 60 million adults in the United States and impacts nearly half of adults over 65. Managing arthritis can be challenging, and combination therapy is often needed for effective management. This article will explore some treatment options available and how Medicare can help pay for them.

What is arthritis?

Arthritis is a chronic condition characterized by inflammation that affects the joints or tissues. Common symptoms include pain, stiffness, swelling of joints, and limited mobility. There are many types of arthritis; common types include:

  • Osteoarthritis. This is the most common form of arthritis, and people most often develop it in their hands, knees, and hips.
  • Rheumatoid arthritis. This type of arthritis is also known as RA. RA is an autoimmune disease, a condition in which the body attacks its own healthy cells, and it causes inflammation within the joints and tissues.
  • Gout. Gout is another form of arthritis that also causes inflammation. People typically complain of gout pain or gout “flares" in their big toes.
  • Psoriatic arthritis. Classified by chronic inflammation of the joints and skin, psoriatic arthritis is commonly accompanied by psoriasis (a chronic skin condition).

What arthritis treatment does Medicare cover?

When managing arthritis, the primary goal is to improve quality of life by reducing pain, decreasing joint damage, and controlling inflammation. This will require the utilization of multiple treatment strategies, including physical therapy, medications, and sometimes surgery. It’s essential for you to understand what treatment options are covered under Medicare.

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  • Surgery. Surgery may be required to treat your arthritis and manage symptoms effectively. Different types of surgery are used to treat arthritis, including osteotomy (bone reshaping), joint revision, and arthroscopy (tissue repair). These surgeries may fall under Medicare A if admitted as an inpatient, or Medicare B if done as an outpatient procedure.
  • Crutches and other medical equipment. If you need a cane or walker due to your arthritis, you may be able to obtain these devices through Medicare Part B. Medicare Part B covers durable medical equipment or DME. To qualify for coverage, your doctor must justify that you need the equipment to manage your arthritis. If you’ve paid your deductible, you will pay 20% of the cost of the equipment.
  • Related chronic conditions. Medicare Part B may also help manage other relevant chronic conditions such as depression. Talk to your physician about creating a chronic care management plan to help manage your arthritis and other health conditions.
  • Consider joining a Medicare Part C plan. Physical activity is an essential part of arthritis treatment. If you’re over the age of 65, consider enrolling in a Medicare Part C plan that can give you access to a free gym membership. These comprehensive plans also provide the same coverage as Medicare Parts A and B, and Medicare Part D is often included.
  • Medicare Part D. You may need medications to help manage your arthritis, especially if you have rheumatoid or psoriatic arthritis. Medicare Part D will cover the cost of your outpatient prescription medications. Depending on the type of medication prescribed, your doctor may need to submit documentation for prior authorization approval. Essentially, your doctor must prove that it is medically necessary for you to have the medication. You should also know that Medicare Part D does not pay for over-the-counter medicines that you may take for your arthritis.

What other coverage is available?

You may want to review either a Medicare Supplement, also known as a Medigap plan, or a Medicare Advantage Plan, also known as Medicare Part C, to help with the non-covered costs of Medicare A and B. A supplement plan is purchased in addition to your Original Medicare plan, and you must already be enrolled in Original Medicare to purchase a Medigap plan. Medicare supplement plans do not cover the cost of prescriptions, so you must purchase a Medicare Part D plan to get coverage for your medications.

A Medicare Advantage Plan is another path to consider for managing costs. These plans may have limited lists of providers or authorization rules, so review them carefully before enrolling. Many include part D drug coverage.

Note
You cannot have a Medicare supplement plan and Medicare Advantage plan simultaneously.

If you need additional assistance beyond the above options, you may want to determine your eligibility for other programs, such as Medicaid or the Extra Help program. Medicaid can help cover the costs of monthly premiums, deductibles, and copayments. The Extra Help program is another Medicare program that can provide additional assistance to help cover the cost of your medications.

Does Medicare cover knee injections for arthritis?

Osteoarthritis commonly affects the knees. If you have arthritis in your knees, you may have considered knee injections. Medicare will help cover the cost of certain injections. Injections with hyaluronic acid and corticosteroids are commonly used to improve pain and function. Hyaluronic acid can provide lubrication, while corticosteroids reduce inflammation. Both treatments can help to alleviate pain symptoms.

Medicare will only cover knee injections with hyaluronic acid for knee osteoarthritis. Before you begin treatment, your doctor must confirm that you have tried other treatment options and that those treatments were unsuccessful. Your doctor should also review your condition with Medicare before treatment in order to guarantee coverage.

The treatment of arthritis must be individualized for your condition and symptoms. Understanding your benefits through Medicare is essential to optimizing and efficiently managing your arthritis. Be sure to speak with your healthcare provider about the available treatment options.

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