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Does Medicare Cover Arthritis Treatment?

Does Medicare Cover Arthritis?

Just the Essentials…

  • Arthritis is an umbrella term for a variety of joint conditions characterized by stiffness, inflammation, and pain.

  • While most arthritis is treated with lifestyle changes, extreme cases may require surgical intervention, which is covered under Medicare.

  • Medicare Advantage offers benefits that can make managing arthritis much easier.

Is your arthritis a pain in the neck (or any other joints)?

When you’re in pain, you need relief fast: but does Medicare even cover arthritis treatment? While Original Medicare certainly covers some arthritis treatment (including bone density tests), it doesn’t necessarily cover everything you’ll need, like medication for pain management. That’s why it’s important to understand your Medicare arthritis coverage and to determine what extra services, if any, you might need.

What is arthritis anyway?

Woman holding her hand as if in pain

That might seem like a silly question when you’re in pain, but there are multiple types of arthritis that require completely different treatments.  

The most common form of arthritis is osteoarthritis, occasionally known as degenerative joint disease. It usually occurs in the hands, neck, lower back, knees, and hips. It occurs when the cartilage in your joints begins to degrade. 

This articular cartilage, as it is called, functions both as a lubricant and shock absorber. It allows the bones to glide over one another with minimal friction and helps absorb the forces we experience in everyday movement. When it degrades, your bones lose that protection, leading to a chain reaction that affects the entire joint: bone, ligaments, muscles, the works. This results in an inflammatory response as your body tries to protect itself from damage, leading to stiffness, swelling, reduced range of motion, and pain. 

You might have also heard of rheumatoid arthritis (RA). Unlike osteoarthritis, which is a result of a variety of physical factors that lead to the degeneration of cartilage, RA has a very specific cause: your immune system. It’s part of a larger class of illnesses called autoimmune diseases. 

Ordinarily, your immune system can tell the difference between what is supposed to be inside your body and what isn’t. If it detects something it considers ‘foreign’, typically a pathogen of some sort, it will attack it. An autoimmune disease occurs when, for some reason, your body mistakes its own cells for a pathogen, leading it to attack itself. That’s where the “auto” in autoimmune comes from: auto being a Greek prefix meaning ‘self’. In RA’s case, the tissue being attacked is in your joints. This also leads to an inflammatory response, as your body mistakenly believes there’s some hazard it needs to protect you from. 

If you ache all over, you might have fibromyalgia. This is a condition that is often comorbid with RA, which affects how our body processes pain. It doesn’t cause pain itself, but it makes any pain you experience considerably worse. Minor aches you wouldn’t even notice become agonizing, and symptoms of things like RA can quickly become unmanageable if left unchecked.

Finally, if your arthritis only manifests in a single joint, such as in your foot, you might have gout. This mostly affects the metatarsophalangeal joint, also known as the base of your big toe. Gout occurs when there is too much uric acid in your body, referred to as hyperuricemia: hyper meaning high, uric referring to uric acid, and -emia meaning presence in blood. 

 

As the name implies, uric acid is typically removed from the body in the form of urine. It’s a byproduct of breaking down purine, a compound found in alcoholic beverages, cured meats, organ meats such as liver, and certain types of seafood. Typically, gout can be treated with a change in diet, but hyperuricemia may also be a sign of kidney disease. 

Arthritis Treatments Under Original Medicare

Undergoing Physical Therapy for Elbow

In the early stages of arthritis, most treatments focus on lifestyle changes. You’ll be asked to lose weight, change your diet, and maybe take some over-the-counter medications. You might also be asked to undergo physical therapy, or use various braces or mobility aids. With the exception of OTC medication, all of this typically falls under Medicare Part B. Any tests to determine the presence of RA or fibromyalgia also fall under Part B

Your doctor may also recommend viscosupplementation, also known as a knee gel injection. These gel shots for the knee are made from hyaluronic acid, which you might have seen in skincare products and vitamins. It’s naturally found in the joints, and the theory is that restoring hyaluronic acid will relieve some osteoarthritis symptoms. Unfortunately, viscosupplementation won’t do much for RA, and isn’t guaranteed to work for osteoarthritis either. Still, it is covered under Medicare Part B.

In extreme cases, you may need to undergo replacement arthroplasty, or joint replacement surgery. The most common joint to be replaced is the hip, but it’s possible to replace shoulders, knees, ankles, and even finger joints. Except for finger joint replacement, these are inpatient procedures requiring a hospital stay. These procedures, including finger joint replacement, require extensive physical therapy and a long recovery period. Hospital stays are covered under Medicare Part A, while physical therapy and any recovery equipment fall under Part B. You might also require some home health care, depending on the procedure. Any pain medication not given by a nurse will need to be paid for out of pocket unless you have a Part D plan, however.

Arthritis Treatments Under Medicare Advantage

Treatments under Medicare Advantage are similar to those under Original Medicare, but with some additional options depending on your plan.

Some plans include an over-the-counter benefit, covering the cost of pain medications like Tylenol. Many also include a prescription drug benefit, covering pain medications you might need. Medicare Advantage plans also include extra hospital days, making recovering from surgery less taxing on your wallet. Since people with arthritis tend to be hospitalized more frequently than average, this can be a big help.

If you have RA, you may qualify for a special needs plan. These plans are designed specifically for people with RA, including prescription coverage and other benefits to treat that condition.

If you’re not sure which plan is right for you, our licensed insurance agents can help. Call us at (800) 950-0608 or enter your zip code into our free comparison tool to begin your search. 

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