Joint health and arthritis
What does Medicare cover for joint health and arthritis?
Chances are, you or someone you love struggles with arthritis. According to the CDC, over 53% of adults age 75 and older have this painful condition. Many individuals hope to ward off arthritis and maintain their cartilage and joint health. There are popular non-prescription supplements, such as glucosamine, chondroitin, and curcumin, but as of now, there is no cure for arthritis. It’s important to understand how Medicare covers treatments, so you can stay mobile and comfortable and do more of what you love.
Medicare coverage for diagnosing arthritis
It’s important to visit your doctor as soon as you suspect you may have arthritis. Medicare insurance plans will cover both your doctor visit and any tests needed, including blood tests, joint fluid analysis, imaging tests, and bone scans. Other factors like obesity or smoking can impact your arthritis, so your doctor may prescribe screenings or request counseling to address those.
Medicare coverage of arthritis treatments
There are treatments that may make life more comfortable and ease the pain associated with arthritis. In most cases, you’ll need a recommendation from your doctor for these, and in cases of purchasing equipment or pursuing physical therapy, you may be required to obtain prior authorization from Medicare.
Part B is the Medicare portion that covers outpatient services, like physical therapy, durable medical equipment (DME), and doctor’s visits. After meeting your Part B deductible, you’ll pay 20% of the Medicare-approved amount.
Arthritis medications
There are different medications that can be used to treat arthritis, such as medicines that limit pain and inflammation, and a prescription will depend on what your doctor recommends. Be sure to check your prescription drug plan, Part D, to make sure they are covered. Medicare Part D is optional, but if you wait to join, you’ll pay a late enrollment penalty for each month you could have signed up, but didn’t.
Physical therapy for arthritis
If your doctor decides physical therapy is medically necessary to treat your arthritis, they will create a treatment plan for you. Physical therapy is beneficial for many with arthritis because it can increase your strength and flexibility, as well as reduce pain and help improve your joint function.
Durable Medical Equipment (DME) for arthritis support
There are many pieces of DME that can help you move more comfortably, and these are covered by Medicare Part B when they’re recommended by your doctor. Some examples of DME for arthritis include braces, orthopedic support, canes, walkers and other walking aids, splints, and more.
Acupuncture for arthritis
At this time, Medicare Part B only covers acupuncture for chronic lower back pain. It doesn’t cover acupuncture for arthritis.
Stem cell therapy for arthritis
Stem cell therapy isn’t approved by the Food & Drug Administration (FDA) to treat arthritis. There is still research to see if this will be an effective treatment in the future. For this reason, Medicare doesn’t cover stem cell therapy for the treatment of arthritis.
Arthritis joint replacement surgery
Sometimes, medication and therapy aren’t sufficient to treat severe arthritis. In those cases, joint replacement surgery may be medically necessary. Check your plan to see what is covered for an inpatient stay, as well as which deductibles and copays might apply.
Chronic care management (CCM) services
If you have one or more chronic conditions, it’s helpful to have care management help plan and manage your health. If you have arthritis in addition to another chronic condition, like diabetes or heart disease, Medicare may cover care management services to help manage medications, coordinate care between providers, provide 24/7 access for any urgent care needs, and more. For those with Original Medicare, this care management would include a monthly fee, plus your 20% coinsurance after you meet your Part B deductible.
Do Medicare Advantage (Part C) plans cover arthritis treatment?
Absolutely. Medicare Advantage plans typically include Parts A, B, and D, and cover everything Original Medicare covers. They have their own deductibles and coinsurance amounts, so it’s important to review your Medicare insurance plan documents or contact them for detailed information.
If you also have Medicaid, a plan called a dual-eligible special needs plan (D-SNP) from Sentara Medicare will provide you with a care coordinator, along with more benefits than Original Medicare, like a monthly grocery allowance,1 over-the-counter products allowance, allowances for dental, vision, and hearing, transportation,2 and more, all for a $0 premium.
Purchasing arthritis supplements with an OTC benefit
Many Medicare Advantage offer an over-the-counter (OTC) allowance as part of their extra benefits. Sentara Medicare’s quarterly OTC products allowance gives members access to hundreds of health and wellness items, such as supplements to aid in joint health, shipped free of charge.
Call today to find out how Sentara Medicare can get you the care you deserve.
1-877-550-3285 (TTY: 711).
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You can also find more information on our website at www.sentaramedicare.com/SNPs
Sources:
World Health Organization
U.S. Centers for Disease Control and Prevention (CDC)
Benefits vary by plan and region. 1Members with chronic condition(s) that meet certain criteria may be eligible for this special supplemental benefit. Benefits vary by plan. This benefit is not available to Sentara Medicare Prime (HMO). 2Pick-up and drop-off locations must be within the service area. Rides are one-way. Trips over 50 miles require authorization. Number of trips vary by plan. Sentara Medicare is an HMO Dual Eligible Special Needs Plan (HMO D-SNP) that has contracts with Medicare and the Virginia Department of Medical Assistance Services’ Medicaid program. “Cardinal Care” is the brand name of Virginia Medicaid. Y0174_0525_SHPJH_460070_C