Does Medicare Cover Arthritis Treatment?
Last Updated : 10/21/20194 min read
Arthritis is a common concern of seniors. The Centers for Disease Control and Prevention (CDC) estimates that over 54 million American adults have arthritis. There are over 100 types. Here’s a quick overview of the most common types, and information about Medicare coverage of arthritis treatment.
What is arthritis?
Arthritis is swelling or inflammation of a joint (a knee, for example) or tissues around a joint, according to the CDC. Depending on what type of arthritis you have, it can affect other parts of your body as well.
What are the most common types of arthritis?
According to the National Institutes of Health (NIH), osteoarthritis is the most common type of arthritis. This is the breakdown of cartilage between bones.
Another common type of arthritis is rheumatoid arthritis, the NIH reports. This is an autoimmune disease, where your immune system attacks your tissues, such as the tissues around your joints.
Psoriatic arthritis (which can affect the skin as well as joints) and gout (a buildup of uric acid crystals in the joints) are other common types of arthritis, notes the NIH.
There are many other types of arthritis, and you can have more than one type at the same time, reports the Centers for Disease Control and Prevention (CDC).
What’s the treatment for arthritis?
Depending on the type of arthritis you have and other factors, there may be several different approaches to managing your arthritis, according to the CDC. Your doctor might prescribe physical therapy or pain medication for you. In some cases, your doctor might recommend surgery.
Does Medicare cover arthritis treatment?
Office visits to your health-care provider may be covered under Medicare Part B, if your doctor accepts Medicare assignment. You’ll likely pay a coinsurance amount, and the Part B deductible applies.
Medicare Part B might cover arthritis as part of its chronic conditions coverage. Generally, this particular coverage only applies if you have more than one chronic health condition.
If your arthritis treatment involves a hospital stay, Medicare Part A generally covers your treatment and services as a hospital inpatient. You’ll generally need to pay the Part A deductible before Medicare starts covering your inpatient services, and a coinsurance amount applies once you’ve paid the deductible.
If your health-care provider prescribes medications for you, be aware that your Medicare coverage might not include prescription drugs you take at home. If you’re hospitalized and admitted as an inpatient, Medicare Part A usually covers medications you take as part of your treatment. Medicare Part B may cover medications administered to you in an outpatient setting.
However, you can typically get Medicare prescription drug coverage by signing up a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. Both types of plan are offered by private insurance companies that contract with Medicare. Each plan has its own formulary, or list of covered medications. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
The Medicare Advantage program lets you get your Medicare Part A and Part B benefits through a private, Medicare-approved insurance company (except hospice benefits, which Part A covers). Medicare Advantage plans might also cover your prescriptions, if they’re in the plan’s formulary. You need to keep paying your Medicare Part B premium, along with any premium the plan may charge.
Instead of signing up for a Medicare Advantage plan, you might consider buying a Medicare Supplement plan to work alongside your Medicare Part A and Part B coverage. Medicare Supplement plans generally cover some of Medicare’s out-of-pocket costs, such as deductibles and coinsurance. However, Medicare Supplement plans sold today don’t cover prescription drugs, so you might want to sign up for a stand-alone Medicare Part D Prescription Drug Plan.
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