According to the Centers for Disease Control and Prevention, there are over 54 million people with arthritis. There is no cure for this disease, although there are treatments to help reduce the inflammation. When someone has arthritis, they experience inflammation in the joints, which can cause pain and stiffness. Over time, wear and tear can cause further damage to the joint, and infections can occur. Those with arthritis can also experience other chronic health conditions such as heart disease and obesity.
There are several kinds of treatments that may help with the symptoms. Massage therapy, acupuncture, and stretching can be used to decrease inflammation. Other options are exercise, heating pads, ice packs, and a cold compress. A doctor may prescribe certain anti-inflammatory medications depending on the pain and recommend surgery to replace the joint. Medically necessary treatment and prescriptions can be covered by Medicare Part B and Part D, respectively.
Common types of arthritis
Arthritis can come in various types and affect different parts of the body. The common types are osteoarthritis, rheumatoid arthritis, fibromyalgia, gout, and psoriatic arthritis.
Also called degenerative joint disease, osteoarthritis can occur in the hands, hips, and knees. As the cartilage in the joint diminishes, the underlying bone will start to change, which can worsen over time. Swelling and stiffness can be common symptoms from this process and eventually reduce a person’s ability to do daily activities.
Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease. The immune system attacks the healthy cells in the body with this form of arthritis. The result is painful swelling in the body parts that are affected. The tissue damage that happens from the swelling can cause chronic pain.
Fibromyalgia causes pain all over the body along with possible fatigue, sleeping problems, and distress. Treatment can help with the pain, but the cause of this disease is unknown.
This form of inflammatory arthritis tends to affect one joint at a time and can flare up then go into remission.
Psoriatic arthritis is another inflammatory arthritis that can affect those with psoriasis. Swelling, stiffness, and pain can occur with this form.
The location of the treatment or procedure will determine which part of Medicare will cover it. Medicare Part A is hospital coverage, and Medicare Part B is medical coverage. Medicare Part D can cover medications the doctor prescribes for treatment.
If you were admitted as an inpatient due to a hip or knee replacement surgery because of arthritis, then Medicare Part A will cover you. There is a $1,484 deductible in 2021. You must meet the deductible first before Medicare helps cover the hospital coinsurance during your stay.
Part A covers a semi-private room, three daily meals, and certain medications and lab work while you are an inpatient.
Medicare Part B will cover approved medical services, including doctor visits for arthritis, lab work, tests, outpatient surgeries, and more. If you are doing physical therapy after a hip or knee replacement surgery, Part B may cover it.
However, Medicare Part B does not cover massage therapy to help with arthritis. Acupuncture may be another recommended procedure. Medicare may cover acupuncture for chronic low back pain, and there is a limit of 20 visits per year.
Part D provides prescription coverage for retail pharmacy drugs. If a doctor prescriptions anti-inflammatory medications to help reduce the swelling and pain, then your Part D plan may help cover the drug. Each Part D plan has a formulary which is a list of the drugs the plan covers. Your cost-sharing will depend on the drug itself and which tier it is.
There is no limit on the out-of-pocket costs a Medicare beneficiary must pay. You are responsible for the Part A and Part B deductibles, 20% of all approved Part B services, and more. You can enroll in a Medigap plan to help with those costs. Medigap plans, such as the Plan G, will leave you with little out-of-pocket costs.
Another option is to enroll in a Medicare Advantage plan. These plans provide an alternative way to receive Medicare benefits. Each hospital stay, doctor visit, physical therapy session, and lab test will have a copay or coinsurance.
Both kinds of Medicare plans help with hospital and medical costs, but your cost-sharing will depend on your chosen plan.
Medicare will cover services that are deemed medically necessary to treat or diagnose a medical condition. Arthritis is a common disease that comes in various forms. Each person may experience the disease differently, and therefore, the necessary treatment can vary with each person. It is essential to know Medicare Part A and Part B does cover medically necessary services for arthritis.