A Guide to Medicare Coverage for Arthritis: Diagnosis and Treatment
Arthritis doesn’t only impact older adults. 21.2% of all adults in the United States have some form of arthritis. With over a hundred different types of arthritis, not everyone benefits from the same type of treatment. Thankfully, Medicare covers various treatment options for arthritis. We’ll go over some of the different arthritis treatments and Medicare coverage for arthritis management in this post.
Key takeaways:
Medicare coverage for arthritis diagnosis and treatment includes doctor visits, screenings, physical therapy, medications, durable medical equipment, and surgery.
Medicare doesn’t cover acupuncture or stem cell therapy for arthritis.
If you have multiple chronic conditions (like arthritis and cardiovascular disease), you may qualify for chronic care management services coverage from Medicare.
What is arthritis?
Arthritis occurs when your joints become inflamed and cause pain. There are many types of arthritis, including osteoarthritis, rheumatoid arthritis, gout, and lupus. Different forms of arthritis often share common symptoms like:
Joint pain
Joint stiffness
Joint swelling
Decreased range of motion
Redness and warmth
Fatigue and weakness
Joint deformities in severe cases
Risk factors associated with arthritis depend on which kind of arthritis you have. Oftentimes, the condition occurs simply due to age. As you age, there’s more wear and tear on your joints. Other risk factors include:
Joint injury
Genetics
Autoimmune disorders
Infections
Metabolic disorders
Obesity
Smoking
Environmental factors like exposure to pollutants
Did you know that arthritis is the leading cause of work disabilities? If you qualify for Social Security Disability Insurance (SSDI), you’ll automatically be eligible for Medicare after receiving benefits for 2 years.
Common types of arthritis
The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Learn the differences between the two below.
Osteoarthritis
Also called the "wear and tear" arthritis, osteoarthritis happens when cartilage that protects the ends of bones wears down over time. This can lead to pain, stiffness, and swelling in the affected joints. Osteoarthritis commonly affects joints in the hands, knees, hips, and spine. People sometimes confuse osteoarthritis with osteoporosis, but they are different bone conditions.
Rheumatoid arthritis
Rheumatoid arthritis is an autoimmune condition that causes the body's immune system to mistakenly attack its own joints. While rheumatoid arthritis shares common symptoms with other kinds of arthritis, it also can cause fatigue, fever, and weight loss.
Medicare coverage for arthritis diagnosis
Medicare will cover doctor visits and tests used to diagnose arthritis.
To diagnose arthritis, your healthcare provider can:
Go over your medical history to check for genetic factors
Check for symptoms of arthritis with a physical examination
Order blood tests, imaging tests, a joint fluid analysis, or a bone scan to assess the severity of your case
You can’t always prevent arthritis, but there are certain risk factors that increase your chances of developing the condition. Your doctor may recommend counseling or additional screenings for obesity or smoking if they are impacting your arthritis.
Does Medicare cover arthritis treatment?
Yes, Medicare covers arthritis treatment. While you can’t cure arthritis, you can make your life more comfortable and ease pain with treatment. Physical therapy, durable medical equipment , medications, and surgery are all covered by Medicare.
For most treatment options, your doctor must recommend the service before Medicare will help pay for it and you’ll pay a 20% coinsurance after you meet your Part B deductible.
How Medicare covers physical therapy for arthritis
If you have arthritis, physical therapy can help improve joint function, reduce pain, increase flexibility, and increase strength. Medicare covers physical therapy sessions as long as they’re medically necessary. Your doctor must create a treatment plan for coverage.
How Medicare covers arthritis medical equipment
Durable medical equipment, like canes and other walking aids, braces and splints, and orthopedic support, can help you move around more comfortably. Medicare covers medical devices recommended by your doctor.
How Medicare covers medications for arthritis
For arthritis, your doctor may prescribe anti-inflammatory drugs, joint injections, or other medications that ease joint discomfort. Make sure the medications are covered under your prescription drug plan.
Medicare coverage of joint replacement surgery for arthritis
In more severe cases, you may need joint replacement surgery for arthritis. Medicare helps pay for joint replacement surgery. Your out-of-pocket costs include 20% of any preparation materials for surgery, the cost of the surgery, and any follow-up care.
Every person’s condition is different. You and your doctor can work together to come up with a treatment plan that helps you feel more comfortable.
Does Medicare cover acupuncture for arthritis?
No, Medicare doesn’t cover acupuncture for arthritis. While acupuncture can help arthritis by reducing inflammation, Medicare only covers the service to treat lower back pain.
Does Medicare cover stem cell therapy for arthritis?
While Medicare may cover stem cell therapy for certain blood disorders, it doesn’t cover the treatment for arthritis. This is because stem cell therapy isn’t yet approved by the FDA for arthritis management.
Arthritis and Medicare coverage for chronic care management
Medicare beneficiaries may not know that they have coverage for chronic care management conditions. If you have arthritis in addition to other chronic conditions, Medicare may cover health management planning services to manage your health conditions together.
In certain cases, you can get coverage for a comprehensive care plan that includes:
Goal-setting
Providers to visit to manage conditions
Medications
Community involvement if necessary
Details around coordination
Chronic care management is a more intensive treatment plan to help you stay on top of your healthcare if you’re managing multiple conditions. Your costs include a monthly fee, your Part B deductible, and the 20% coinsurance. Secondary insurance, like Medicaid, could help cover the monthly fee.
While not all healthcare providers offer chronic care management, it’s worth asking your doctor what services they provide and if they can provide any advice to manage your conditions.
Get help understanding your Medicare plan
Arthritis is a painful condition without treatment. Knowing how Medicare covers treatment options for arthritis is important to living comfortably and maintaining mobility. Sometimes, you may need multiple types of treatment for your arthritis, which can make your Medicare costs more complicated. If you need help understanding your Medicare plan and how it covers arthritis treatment, call a Chapter Medicare Advisor at 855-900-2427 or schedule a time to chat.