Is Arthritis Covered by Medicare?

Is Arthritis Covered by Medicare?

Arthritis is a common concern for people in the United States. It is estimated by the Centers for Disease Control and Prevention (CDC) that 58.5 million American people are affected by arthritis. But, what’s even more surprising is that there are more than 100 kinds of arthritis, according to the Arthritis Foundation.

The risk is not limited to adults, but children are also exposed. However, does Medicare cover it? Please continue reading to know the answer, but before that, here’s some basic information about arthritis.

What is Arthritis?

Arthritis is a condition that can be described as swelling or inflammation of one or more of the joints, such as the knee joint, wrist, knuckle, etc. Arthritis can also grow into joint pain, swelling, and stiffness.

It is generally diagnosed after physical exams, blood tests, and X-rays, followed by physical conditions or symptoms.

Common Types of Arthritis

Following the National Institutes of Health (NIH) data, osteoarthritis is among the most common types of arthritis. It’s caused by cartilage degeneration in joints that connect bones.

Another form of arthritis that’s common is rheumatoid, as per NIH notes. It is an autoimmune disorder that develops when your immune system attacks your body tissues, including joints.

According to the NIH, psoriatic arthritis (which could be a problem for skin and joints) and Gout (an increase in uric acid crystals inside joints) are also common types of arthritis.

According to the Centers for Disease Control and Prevention (CDC), there are various kinds of arthritis, and it’s possible to suffer from multiple types of arthritis simultaneously, according to the Centers for Disease Control and Prevention (CDC).

Cost of Arthritis Treatment?

The treatment options may vary based on the stage of the disease and the extent of the need for treatment. A healthcare professional will create the most suitable treatment plan for your needs. 

It isn’t easy to estimate the price you will pay for treatments, though you could consider the following factors for an idea of the treatment cost:

Doctor Visits via Appointment in Person or via Virtual Visits

Many arthritis patients attend regular appointments with their primary care physician (PCP) to track the progression of their illness. In addition, your physician may send you to an expert in rheumatology. They treat chronic inflammation and autoimmune disorders, which affect the joints, muscles, ligaments, and tendons.


Medications cost may vary depending on the type of arthritis you have. For instance, psoriatic arthritis is frequently treated by laboratory medicines like NSAIDs. One of the prescriptions is Methotrexate, an inexpensive drug available as a tablet or injection that is quite common to treat PsA, which most plans cover.

Thus, prices vary from low (Methotrexate) to relatively high (HUMIRA).

At-Home Care 

You could need help with your everyday activities at home if your arthritis is severe enough.

Other Expenses

Images of radiology can be essential guides to aid your doctor in diagnosing arthritis and monitoring treatment’s progress. In some cases, you might need physical therapy with a professional therapist to improve movement and performance or even mental therapy to deal with the mental burden while fighting the disease.

Does Medicare Pay for Arthritis Treatment?

Based on the type of arthritis you are suffering from and other aspects, the treatment ways to control your arthritis may vary. For example, the doctor may suggest pain treatment or recommend surgery in severe cases.

Original Medicare could cover consultation with your doctor if your doctor accepts Medicare. Here’s what different parts of Medicare can help you with your arthritis treatment. 

Original Medicare Coverage

If your arthritis treatment needs an inpatient hospitalization, Medicare Part A will generally cover the treatment and services you receive as an inpatient. However, you’ll need to pay the Part A deductible before the time Medicare starts to pay for hospitalization.

The provided medication during inpatient treatment will be covered under Part A. However, this does not cover prescription drugs if you’re admitted into the hospital for being a patient. Medicare Part A typically covers any medication you’re taking as part of inpatient treatment. Besides hospitalization, Part A covers Skilled Nursing Care on short-term and home health care when eligible.

On the other hand, Medicare Part B may assist you with medication for infusion or injection.

If needed, Medicare Part B also covers your need for DMEs like cranes, crutches, or walkers. Besides, mental health support is also covered in the form of therapies under Part B, which usually occurs due to disruption in routines, causing exhaustion.

Medicare Advantage Coverage

You can get prescription coverage by signing up for an individual Medicare Prescription Drug Plan or Medicare Advantage Plan with drug coverage. 

Private insurance companies offer Part C, also known as Medicare Advantage, which provides coverage similar to Part A & B, which are elements of Original Medicare. 

Besides, it also covers your prescription drug costs. Each plan comes with its own formulary or list of medications covered. The formulary of a particular plan may change at any time. However, you’ll be notified of your plan if it happens.

Prescription Drug Part D Coverage

Medicare Part D covers your prescription drug for the treatment. It covers the brand-name and generic medications listed in your plan’s formulary. However, you have to pay the deductible before getting any cost assistance.

If listed in your plan, your drug cost will depend on its drug group. If not, you can choose a similar one. Your drug cost also depends on how much you have spent on medications in a year. You’re likely to pay more if you have entered the donut hole.

More about Donut Hole here; 

Medicare Part D Donut Hole: What is It and How to Avoid It?

The Bottom Line

Medicare covers the majority of your arthritis expenses. However, you’ll be required to pay premiums, copayments, and deductibles. 

You might want to consider a prescription drug plan or Part D that covers the current prescription or an alternative to lower the cost that you pay for prescription drugs.

If you want to lower your medicare expenses, you can apply for different MSPs (Medicare Savings Program). Do you need assistance finding what Medicare plan and MSP will be good for you? Then, contact us now!

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