top of page

Which Osteoarthritis Treatments Are Covered by Medicare?

Writer's picture: Sean SmithSean Smith

Living with osteoarthritis can be challenging, but Medicare offers coverage for a range of treatments to help manage this condition. If you or a loved one is navigating osteoarthritis while on Medicare, understanding your treatment options and their coverage is crucial for maintaining health and mobility without breaking the bank. Here is a detailed guide on what Medicare covers for osteoarthritis treatments and how to make the most of your benefits.


Medicare osteoarthritis treatments.
Medicare osteoarthritis treatments

Medicare Part A: Hospital and Inpatient Care

Medicare Part A generally covers hospital stays and inpatient care related to osteoarthritis, including surgeries like joint replacements. For instance, if you require knee or hip replacement surgery due to severe osteoarthritis, Medicare Part A will cover:

  • Hospital stay costs

  • Operating room fees

  • Necessary medications administered during your stay


However, you will need to meet the deductible, and co-insurance may apply depending on the length of your hospital stay.


Medicare Part B: Outpatient Care and Therapy

Medicare Part B is essential for outpatient treatments for osteoarthritis, including:

  • Physical Therapy: Medicare covers physical therapy sessions aimed at improving mobility and reducing pain.

  • Doctor Visits: Specialist consultations, including rheumatologists and orthopedic surgeons, are covered.

  • Diagnostic Imaging: X-rays and MRIs required for diagnosing or monitoring osteoarthritis are eligible.

  • Injections and Medications: Treatments like corticosteroid injections and hyaluronic acid injections may be covered when deemed medically necessary.


Note that Medicare Part B typically requires a 20% coinsurance after meeting the annual deductible.


Medicare Part D: Prescription Drug Coverage

Medicare Part D helps cover prescription medications for managing osteoarthritis pain and inflammation, such as:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Disease-modifying antirheumatic drugs (DMARDs)

  • Topical treatments for localized pain relief


Make sure your chosen Medicare Part D plan includes the medications you need in its formulary.


Medicare Advantage Plans (Part C)

Medicare Advantage (MA) plans often provide additional benefits beyond Original Medicare. Many MA plans cover:

  • Fitness programs like SilverSneakers

  • Chiropractic care

  • Additional physical therapy sessions

  • Over-the-counter allowances for pain-relief items

Check with your MA plan provider for specifics about your coverage.


Durable Medical Equipment (DME)

If you require assistive devices due to osteoarthritis, such as braces, walkers, or canes, Medicare Part B covers these items when prescribed by a doctor. The equipment must be deemed medically necessary.


What Medicare Does Not Cover

While Medicare covers many osteoarthritis treatments, it does not include:

  • Alternative therapies like acupuncture (unless part of an MA plan)

  • Over-the-counter supplements and pain relief medications

  • Long-term custodial care


How to Maximize Your Benefits

  1. Speak with Your Doctor: Ensure all treatments are documented as medically necessary.

  2. Understand Plan Limitations: Review your Medicare plan annually to confirm it meets your needs.

  3. Explore Supplemental Insurance: Medigap plans can help cover out-of-pocket costs like copayments and deductibles.

  4. Utilize Preventive Services: Medicare Part B covers annual wellness visits and some screenings that can aid in managing osteoarthritis proactively.


Understanding what Medicare covers for osteoarthritis treatments is key to managing the condition effectively. From hospital care and physical therapy to prescription medications and durable medical equipment, Medicare offers a range of options to help you lead a healthier, more comfortable life. Be proactive in exploring your coverage and consult your healthcare provider to develop a treatment plan tailored to your needs.


Sources:

  1. Medicare.gov: https://www.medicare.gov

  2. Arthritis Foundation: https://www.arthritis.org

  3. Centers for Medicare & Medicaid Services: https://www.cms.gov



13 views0 comments

Comments


  • TikTok
  • Pinterest
  • Twitter
  • LinkedIn
  • Instagram
  • Facebook

© 2024 - A Touch of Love Home Care, LLC. Website created by Sam Calvo

DCP registration #: HCA.0001432 | Privacy Policy

bottom of page