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Can I Get Medicare Coverage for Arthritis?: Find your options

medicare arthritis coverage

Arthritis is a prevalent ailment that is most common among elderly adults. Based on an estimation made by the Centers for Disease Control and Prevention (CDC), there are about 55 Million adults in the United States living with arthritis. Medicare may cover medically necessary services and supplies for the treatment of arthritis, including joint replacement surgery. In this article, we will talk about medicare arthritis coverage to save your out-of-pocket expenses. 

Curtailing this disease has become a top priority in the United States when you consider the wide number of people with arthritis. There are several variants and types of arthritis, each with its peculiarities; recent research showed that there are over 100 different types of arthritis, all of which have similar yet different symptoms.

Broadly characterized by the inflammation and swelling of joints and joint tissues as well as the stiffness of these joints, this disease worsens with age. Hence, it is more common among older adults.

The most popular forms of the disease are osteoarthritis and rheumatoid arthritis. However, other variants are equally challenging, and depending on the arthritis you have, the pain and joint inflammation may affect other parts of your body negatively.

Getting adequate care for arthritis is quite expensive, and depending on the severity and type of arthritis a person has, one might have to spend thousands of dollars to get adequate care. Well, the good thing is most individuals spend less on healthcare nowadays with the help of healthcare insurance.

These health insurance plans do not eliminate the cost, but it offers great relief and makes the payment lesser depending on the health insurance plan and insurance company too. The health insurance plans, however, do not solve the financial woe of arthritis treatment when you consider the cost.

Only drug prescriptions for arthritis treatments might amount to about $2,000 yearly, not to talk of the enormous amount you’d pay for hospital visits and therapies which might cost as much as $2,800 monthly; really high right?

Well, if you are wealthy and you could afford a platinum health insurance plan that would cover as much as 99% of your health insurance expenses, then you’re good to go! Yet, most elderly adults are retired and struggle financially, meaning normal health insurance plans might not be as effective.

Now, there’s the option of Medicare plans, especially when you consider the fact that the majority of our Medicare recipients are older adults. Oftentimes individuals ask, “Can my Medicare plan cover my arthritis treatment?” Well, this is only logical, right?

Medicare is specific for the disabled and elderly hence, it should offer coverage for services common amongst the said category of people. Well, you’re not wrong; Medicare does give health insurance coverage for individuals with arthritis.

With Medicare, recipients can access arthritis coverage via their enrolled plan, however, factors like the type of arthritis and its severity are to be considered. Medicare will offer arthritis coverage only when a doctor has recommended arthritis care.

Medicare does not cover every single aspect of arthritis care, some you’d have to sort out yourself or look for an alternative. However, there are various segments of Medicare each of which takes care of a specific aspect of arthritis coverage.

It is good to note that the type of arthritis a person has, as well as its severity determines the type of coverage they receive. Below are the various Medicare plans and the aspects of arthritis coverage they tackle.

 

does medicare cover arthritis

 

Original Medicare Part A

Medicare Part A is one of the two original Medicare plans available to all medicare recipients by default. This plan generally covers health expenses incurred by inpatients.

The original medicare plan would offer health insurance coverage for Individuals with arthritis that require hospital admission. Before Medicare begins to pay for your arthritis expenses, you’d have to pay the deductible for Medicare Part A after which you’d still have to pay the coinsurance amount too.

Although Medicare Part A would cover every expense incurred during your stay in the hospital as an arthritis patient, including prescription coverage, you must note that Medicare Part A would not cover outpatient expenses.

So, if there’s a drug prescription that you’d have to sort outside the clinic or buy at home, Medicare Part A would not cover it. Medicare Part A only covers drug expenses for drugs you’d take as treatments while in the hospital. Anything outside that would require another alternative.

 

Original Medicare Part B

Certain healthcare services that do not require inpatient care, like office visits to health centers, impromptu treatments, and every other health service where the patient would leave the hospital, would not be covered by Medicare Part A.

However, the second Original Medicare Plan, Medicare Part B, offers health insurance coverage for such service. Hence, if your doctor accepts Medicare, you’d have to pay a coinsurance amount with which the Part B deductible applies.

Nevertheless, for arthritis patients that receive outpatient care, Medicare Part B would offer coverage only when arthritis is classified among its chronic health conditions. Medicare Part B can only cover arthritis expenses when it is outpatient care and only when the individual has more than one chronic health condition.

 

Medicare Part D / Prescription Drug Plan

Sometimes drug prescriptions for health arthritis treatments are quite expensive, and even with the Original Medicare coverage, the ductile is still quite expensive, and some elders might be unable to afford it still.

In cases like this, a stand-alone Drug Prescription Medicare plan might be the most suitable. This government-sponsored private plan is offered by most health insurance companies that offer Medicare plans.

The Medicare Part D plan has specific requirements that must be met before an arthritis patient can get prescription coverage. These requirements differ from health insurance company to company; hence, individuals must confirm requirements before they apply for these plans.

 

Medicare Advantage Plan

Also called the Medicare Part C plan, the Medicare Advantage plan is an alternative plan to the original Medicare plans with added benefits that are not in the original medicare plan.

With this plan, you can get Medicare Part A and Medicare Part B benefits as well as other health services through a private health insurance company approved by Medicare. As regards arthritis treatment, the Medicare Advantage plan covers drug prescriptions as well as coverage for some uncommon arthritis types that might be absent from the original medicare plans.

However, because the Medicare Advantage plan functions in tandem with the original Medicare plans, you’d still have to pay for your original medicare plans to enjoy maximum coverage.

 

Medicare Supplement

Medicare Supplement is a medicare pseudo-plan that works similarly to the Medicare Advantage plan. Although you cannot use this plan simultaneously with the Medicare Advantage plan, you can also use it to cover out-of-pocket expenses like copayments and deductibles for arthritis treatments.

Also called the Medigap plan, this plan can serve as an alternative to the Medicare Advantage plan since you can also use it alongside the Medicare Part A and Part B plans.

One downside of recent Medigap plans is that they don’t cover drug prescription coverage. Hence, you’d have to support the plan by signing up for a stand-alone Drug Prescription plan via Medicare.

 

Does Medicare Cover Physical Therapy For Arthritis?

Medicare generally offers coverage for health services that are classified as “medically necessary” and required. Hence, whether or not Medicare would cover your physical therapy depends on the reason for the therapy.

Since physical therapy is for treating arthritis, Medicare might cover the expenses, but this therapy would have to be prescribed by a health professional. So, since we can agree that physical therapy classifies as an outpatient service, the Medicare Part B plan would offer coverage depending on the type of arthritis, severity, and other eligibility that must be met.

 

Medicare Coverage For Knee Injections

There are various methods of treating arthritis depending on the severity of the condition and the specific type of arthritis. One of these treatment methods is the injection of cortisone and hyaluronic acid to the knees for very fast and temporary pain relief, mostly used for patients with osteoarthritis.

These Injections are expensive as one injection could last months before the effect wears out. Hence, not all can afford it. However, with Medicare, you can get coverage for your knee injection, but that’s only if the injection is approved by the Food and Drug Administration (FDA).

This method is very effective; sometimes it lasts as long as six months; although it is not a treatment or a permanent solution, it helps individuals to perform certain tasks and live pain-free lives for a while also.

Also called Viscosupplementation, knee injection should be considered before knee replacement. With the help of Medicare coverage, this option can be utilized without any issues as much as Medicare has FDA approval.

 

Elderly Arthritis Treatment Coverage by Medicare

Arthritis is one of the most common diseases amongst older adults due to its advancement with age. Most times, it is transferred genetically. Hence many young individuals have it in them even though they’d not face the symptoms now.

However, as time goes by, their joints become weaker, and movements become more difficult and restricted as the individual gets older with age. Sometimes, it is even difficult for some adults to have a proper grip.

Well, regardless of the situation, you can get arthritis coverage via Medicare as an older individual. There are various plans and services that you can explore depending on the severity of your arthritis and the type of arthritis too.

A very severe case might require care in Nursing homes; milder cases could be quelled by physical therapies, knee injections, etc. It is good to note that Medicare would cover all of the following expenses if it is required and approval from the required body is given.

 

Frequently Asked Questions

Does Medicare cover arthritis?

Yes, with the right Medicare plans and coverage, you can get coverage for arthritis problems, especially as a senior. All you need to do is find the right Medicare plan, be it an Original Medicare plan, Medicare Part A or Part B, whichever is right for you.

It’s worthy of note that the different Medicare plans offer different coverage policies for the different services available. As for leg braces, knee braces, and similar health services, Medicare Part B would suffice.

Does Medicare cover leg braces?

An essential piece of equipment in the life of an elderly person, especially one who has arthritis, is leg braces. The Part B plan of Medicare covers leg braces services as a therapeutic service for arthritis treatment as well as many other orthotics, including arm, knee, and back braces.

Medicare will only pay for leg braces if they are deemed medically essential, which means they must be used to treat or manage a condition. For a leg brace to be partially covered by Medicare, your doctor must sign certifying documents stating that you require such a leg or knee brace.

You can receive a sleeve, wraparound, or another type of brace for a milder knee issue, but Medicare won’t pay for it. These braces are available in physical locations and online. You can ask your doctor which of the types of braces is ideal for you if you don’t yet require a hinged leg brace.

How much would knee braces cost under Medicare coverage?

Part B of Medicare covers knee braces, so 80% of your out-of-pocket expenses for durable medical equipment will be covered. Once you have paid your deductible for the year, which for Part B in 2018 is $183 per calendar year, you will be required to pay the remaining 20%. The complete cost of knee braces can be reimbursed by your Medicare Advantage plan with no out-of-pocket expenses.

Since knee braces vary in price, it’s difficult to predict exactly how much you will have to pay out-of-pocket. They can cost less than $100 (for milder arthritis) or more than $1,000.

Here, your doctor can be of assistance. He or she might have suggestions for Medicare-approved, reasonably priced knee braces that work well. Additionally, your doctor might recommend that you visit an orthotics expert who can help you get fitted for a personalized knee brace.

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