Rheumatoid Arthritis Treatment and Medicare Coverage

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 12/17/2016

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According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, about 1.5 million Americans have rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic autoimmune disease that causes pain, stiffness, swelling, and loss of function in the joints. Doctors use a variety of tools, including your medical history, physical examination, and laboratory tests, to diagnose the disease. Although there is no RA cure, the news is encouraging on the rheumatoid arthritis treatment front. Advances in prescription drug therapy make it possible to relieve the most disabling symptoms and even achieve remission in some patients.

What are some rheumatoid arthritis treatment options?

There are various approaches to rheumatoid arthritis treatment; your health-care provider will likely recommend some combination of the following to help limit joint damage and provide arthritis pain relief. Your rheumatoid arthritis treatment regimen will depend on how long you’ve had RA, how severe your symptoms are, and the amount of joint damage and disability you have.

Prescription drug therapy

You can use medications for arthritis pain relief, to reduce inflammation, or even to try and slow the course of the disease.

Some rheumatoid arthritis treatment medications include: 

  • Disease-modifying antirheumatic drugs (DMARDs). These are the first line of treatment for people with RA, because they not only provide arthritis pain relief, they also slow the progression of the disease, preventing permanent damage. The American College of Rheumatology says that DMARDs “have greatly improved the symptoms, function and quality of life for nearly all patients with RA.” Some common brand-name DMARDs include Rheumatrex, Arava, and Plaquenil.
  • Biologics are another form of DMARDs prescribed for patients with severe disease. These medications are genetically engineered to help reduce inflammation and structural damage to the joints, and include brand-name medications such as Enbrel, Orencia, Humira, and Remicade.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium are available over the counter for arthritis pain relief. Stronger prescription NSAIDs may also be used to reduce swelling and inflammation.
  • Oral steroids such as prednisone help slow joint damage and relieve pain and inflammation.

It’s important to note that many of the prescription drugs used in rheumatoid arthritis treatment have potentially serious side effects, including lung infections, liver damage, and suppression of bone marrow production. Be sure you understand the risks and benefits of any rheumatoid arthritis treatment your doctor recommends.

Physical and occupational therapy

You may be referred to a physical therapist to help you learn exercises to maintain joint flexibility and range of motion. Your physical therapist may also recommend assistive devices such as walkers or canes to help with mobility, or braces and arthritis gloves to protect tender, swollen joints. An occupational therapist can assist you with adaptive devices to help you perform daily living activities such as dressing and preparing and eating meals.

Surgery

When prescription drug therapy doesn’t provide arthritis pain relief or halt damage to your joints, you and your doctor may decide surgery is the best course for rheumatoid arthritis treatment.

Procedures may include:

  • Surgery to remove the swollen, inflamed lining of the knee, elbow, wrist, and hip joints (known as synovectomy)
  • Surgery to repair ruptured or loosened tendons
  • Fusion to stabilize and realign a damaged joint and provide arthritis pain relief
  • Total joint replacement with a metal and/or plastic prosthetic joint

Self-management

If you have rheumatoid arthritis, there are steps you can take to improve your ability to function independently and remain positive.

These lifestyle behaviors include:

  • Rest and exercise: Rest can help you reduce active joint inflammation, while exercise is important for strong muscles and flexibility.
  • Stress reduction: It may be a good idea to try different techniques to cope with any elevated stress levels that come from the emotional and physical challenges of RA
  • Healthy diet: With some exceptions, there is no scientific evidence that any specific food helps or harms if you have RA, but an overall nutritious diet may be important.

Some people also try alternative or complementary treatments including nutritional supplements (fish oil and plant extracts such as primrose, black currant, and borage, for example) and even tai chi to help them relax and reduce the stress that may make rheumatoid arthritis symptoms worse.

Does Medicare cover rheumatoid arthritis treatment?

You are covered for medically necessary treatment for rheumatoid arthritis under Original Medicare (Part A and Part B), subject to allowable charges and any deductibles, copayments, and coinsurance amounts you may be responsible for. Part A covers treatment you receive in an inpatient setting, including hospitalization, surgery, rehabilitation, and skilled nursing care. Part B helps cover medically necessary services for rheumatoid arthritis, including doctor visits and diagnostic tests, and medically necessary devices and equipment (known as durable medical equipment) your doctor recommends. Part B also helps cover medically necessary physical and occupational therapy from most outpatient providers, usually until a therapy cap is reached, though you may qualify for an exception to the therapy cap limits. The cap limits may change from year to year. Please note that Medicare generally doesn’t cover alternative medicine therapies or treatments, including vitamins and supplements.

Medicare also covers certain prescription drugs for rheumatoid arthritis treatment if they are administered in a health-care setting by a credentialed health-care provider, such as medications that are injected or infused into the blood stream. Original Medicare does not cover prescription drugs you take at home, but you may be eligible to enroll in a stand-alone Medicare Part D Prescription Drug Plan that works alongside your Original Medicare coverage, or as part of a Medicare Advantage plan that includes prescription drug coverage. Medicare Advantage is another way to receive your Original Medicare (Part A and B) benefits, except for hospice care, which is still provided by Part A. Deductibles, copayments, and/or coinsurance amounts may apply.

Do you need information about managing your rheumatoid arthritis treatment expenses under Medicare? Or, would you like to learn more about coverage under different Medicare plan options? I’m happy to help. Get information via email or request a phone call at your convenience by clicking one of the links below. You can see a list of plan options you may qualify for in your area by clicking the Compare Plans or Find Plans buttons. For immediate assistance, please call me or one of our licensed insurance agents. You can find out more about me by clicking the “View profile” link below.

Call Medicare.com’s licensed insurance agents at 1-844-847-2660 (TTY users 711) Monday through Friday, 8AM to 8PM ET

For more information, see:

“Handout on Health: Rheumatoid Arthritis,” National Institute of Arthritis and Musculoskeletal and Skin Diseases, last updated February 2016, http://www.niams.nih.gov/health_info/rheumatic_disease/

“Rheumatoid Arthritis,” American College of Rheumatology, last updated August 2013, http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis

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Pamela Cannaday |
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Licensed Insurance Agent since 2011
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