Does Medicare Cover Gout?
Last Updated : 10/06/20184 min read
You may be surprised to learn that gout is actually a form of arthritis, although it’s a very complex type, according to the Mayo Clinic. If you have gout and are covered under Medicare, here’s what you need to know.
What is gout?
Unlike many types of arthritis that are accompanied by chronic joint pain, gout tends to present with sudden attacks of sharp, stabbing pain, most often in the big toe, although it can also affect the fingers, wrists, elbows, knees, and ankles.
The attacks happen suddenly, usually at night, according to the Mayo Clinic, and can be so painful, even the weight of your bed sheet seems intolerable. During an attack of gout, the pain is worst during the first 12 hours, although you may have lingering discomfort for a few days or weeks.
As gout progresses, you may have more severe attacks that last longer and affect more than one joint. Untreated gout can cause joint damage, so it’s important to see your doctor if you think you have the condition.
What causes gout?
According to the Mayo Clinic, gout is caused by a buildup of urate crystals in the joints. Urate crystals are formed when there is too much uric acid in your blood. Certain foods, such as red meat, seafood, alcohol, and beverages sweetened with fructose contribute to high uric acid levels. If you have gout, your doctor may advise you to avoid those foods.
Other risk factors for gout include:
- Medical conditions such as diabetes and high blood pressure
- Family history of gout
- Certain medications such as diuretics to treat hypertension, and even aspirin
You may be able to prevent gout by eating a diet low in red meat, fish, and poultry, increasing your fluid intake, avoiding alcohol, and maintaining a healthy weight.
What is the best gout treatment?
The Mayo Clinic suggests that medications are the most effective type of gout treatment. For some people, these include non-steroidal anti-inflammatory drugs (NSAIDs) such as over-the-counter ibuprofen, and prescription NSAIDs such as Celebrex and Indocin.
Colchicine is another frequently prescribed gout treatment, although it may cause nausea and diarrhea, making it difficult for some people to tolerate at high doses.
Your doctor may also use corticosteroids, either by mouth or injected directly into the affected joint, for gout treatment.
How does Medicare cover gout treatment?
In general, Medicare covers all medically necessary doctor visits and tests to diagnose and treat gout. After you meet your Medicare Part B deductible, Medicare generally pays 80% of allowable charges. Your cost sharing may be different if you have a Medicare Advantage plan. Medicare Advantage is another way to your Medicare Part A and Part B coverage through a private insurance company. Medicare Advantage plans must cover everything that Medicare Part A and Part B covers, with the exception of hospice care, which is still covered by Medicare Part A. Medicare Advantage usually also covers additional services that Medicare Part A and Part B don’t cover.
Medicare Part B may cover steroid injections when administered in a doctor’s office or outpatient center. However, Medicare Part A and Part B generally don’t cover prescription drugs for gout treatment that you take at home. On the other hand, if you have Medicare Part D coverage for prescription drugs, your gout treatment medications should be covered under your plan. You may have to meet a deductible and pay a copayment. Most Medicare Advantage plans come with Part D coverage. You can also get a stand-alone Part D Prescription Drug Plan.
A Medicare Supplement Plan is another option to help pay your out-of-pocket costs for gout treatment. Medicare Supplement Plans, or Medigap, pay some or all of your Part A and/or Part B deductibles and coinsurance amounts. In general, however, Medicare Supplement does not cover any costs associated with prescription drugs.
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