How Medicare Helps Manage Arthritis in Seniors and People With Disabilities
Key Takeaways
- About 54 million U.S. adults live with arthritis, including millions of people on Medicare.
- Original Medicare can cover treatment and services such as diagnostic exams, chronic care management, physical therapy, and surgery.
- For arthritis medication coverage, you need a Medicare Part D or Medicare Advantage Prescription Drug plan from a private insurance carrier.
- Based on where you live, there may be a Chronic Condition Special Needs Plan available that’s right for you.
Arthritis is not just one health condition, but the term used for over 100 different chronic conditions affecting joints and other connective tissues. According to data from the Centers for Disease Control and Prevention (CDC), about 54 million U.S. adults live with some type of arthritis. That population includes more than a third of enrollees in Original Medicare, the public health insurance program for people who are at least 65 years old or have certain disabilities.
Either Original Medicare or a Medicare Advantage plan from a private insurance carrier can provide coverage and services to manage arthritis, such as physical therapy, medication, surgery, and assistive devices. By learning about your insurance options, you can make the right choices to pursue a more fulfilling life with arthritis and other chronic conditions.
Ready for a new Medicare Advantage plan?
Medicare Arthritis Coverage
Medicare offers coverage for arthritis treatment and resources. While there’s no cure for these conditions, you can work with healthcare providers to improve your everyday life by reducing joint pain, stiffness, and other symptoms.
Medicare Part A, which is hospital insurance, covers medically necessary inpatient procedures related to arthritis, such as a total joint replacement.
Medicare Part B, the part of Original Medicare that provides medical insurance, covers:
- Diagnostic exams: Physical exams, X-rays, and lab tests may be medically necessary to diagnose your condition.
- Chronic care management services: If you have at least one more serious chronic condition in addition to arthritis, such as diabetes, Medicare helps pay for working with a healthcare provider to develop and coordinate a comprehensive care plan that meets your individual needs.
- Physical and occupational therapy: Physical therapy sessions can reduce pain while building strength and flexibility in the affected joints. Occupational therapy teaches people with arthritis to complete everyday tasks while minimizing pain and using assistive devices if needed.
- Durable medical equipment: Part B covers mobility equipment like crutches, canes, and walkers, which may be necessary if arthritis makes walking painful.
Arthritis Drug Coverage on Medicare
Original Medicare generally covers medications administered in the hospital or doctor’s office, but not the ones you take at home. You will need a Medicare Part D prescription drug plan from a private insurance carrier for medications to control arthritis symptoms, such as:
Non-steroidal anti-inflammatory agents (NSAIDs): Used to reduce inflammation and improve joint functioning. Over-the-counter aspirin is one example, but you may respond better to a prescription-strength NSAID medication.
Corticosteroids: Drugs like hydrocortisone and prednisone are used both to fight inflammation and regulate the immune system.
Disease modifying anti-rheumatic drugs (DMARDs): Immunosuppressant medications like hydroxychloroquine, sulfasalazine, and leflunomide may slow the spread of certain conditions, minimize damage to your bones and joints, and maintain your joint function.
Does Medicare Cover Acupuncture for Arthritis?
Original Medicare does not cover acupuncture for arthritis. Part B only provides acupuncture coverage in situations where you experience chronic lower back pain with no known cause. Medicare Advantage plans may offer more coverage than Original Medicare.
Does Medicare Cover Stem Cell Therapy for Arthritis?
Medicare covers stem cell therapy for certain cancers and bleeding disorders, but not for arthritis. While there has been some research into using stem cell therapies to manage arthritis, no treatments have been approved by the U.S. Food and Drug Administration.
Medicare Advantage and Chronic Condition Special Needs Plans (C-SNPs) for People With Arthritis
Medicare Advantage plans from private insurance carriers must at least match the coverage you would get from Original Medicare and may offer additional benefits. However, plan availability depends on where you live; you generally need to visit doctors and pharmacies in a provider network to get the most out of your coverage.
A Special Needs Plan (SNP) is a Medicare Advantage plan designed to serve a specific population. Chronic Condition Special Needs Plans (C-SNPs) feature coordinated care services, Medicare Part D prescription drug coverage, and often other benefits to assist people with certain conditions. Those with rheumatoid arthritis are eligible to enroll in a C-SNP where available.
Generally, you are only able to switch from Original Medicare to a Medicare Advantage plan or from one Medicare Advantage plan to another at certain times, such as the Annual Enrollment Period (Oct. 15-Dec. 7). However, when you’re diagnosed with a condition that’s covered by a C-SNP available in your area, you are eligible for a Special Enrollment Period so you can join. A licensed insurance agent or broker can help explore your options.
Ready for a new Medicare Advantage plan?
Understanding the Types of Arthritis
Each type of arthritis may have differences in symptoms and in the most effective course of treatment. Some of the most common conditions are:
- Osteoarthritis
- Rheumatoid arthritis
- Gout
- Psoriatic arthritis
Osteoarthritis
Osteoarthritis affects about 33 million adults in the U.S. and hundreds of millions around the world, more than any other form of arthritis. Symptoms include pain, stiffness, swelling, and a loss of flexibility, often occurring in the hands, spine, knees, and hips.
This form of arthritis occurs as the cartilage in joints wears down, leaving bones to rub against each other. You’re more likely to develop osteoarthritis as you grow older, especially if you’re a woman. The risk is worse for people who put repeated stress on a joint, who are obese, or who have a family history of the condition.
Treatment for osteoarthritis often involves taking pain relievers as well as physical therapy. You may prevent the condition from getting worse by getting regular exercise, maintaining a healthy weight, and protecting your joints from stress.
Rheumatoid Arthritis
This autoimmune disease can develop at any point in your life, but it’s more likely to occur as you age. You’re at higher risk if you’re a woman, you have a family history of the condition, or you smoke.
In rheumatoid arthritis, your immune system attacks the tissue in your joints, often starting in the hands and feet before spreading.
What Are the 4 Stages of Rheumatoid Arthritis?
- Stage 1: The tissue around one or more joints becomes inflamed, which may result in some pain and stiffness.
- Stage 2: Inflammation begins to damage cartilage in your joints. You might feel stiff and lose some range of motion.
- Stage 3: Inflammation starts to damage your bone, and you experience more pain and stiffness while losing more of your range of motion.
- Stage 4: Inflammation stops, but you experience severe pain, swelling, stiffness, and loss of movement in your joints.
To manage this type of arthritis, you may take NSAIDs, corticosteroids, or DMARDs, and also undergo physical therapy. If you develop joint damage, your doctor may recommend surgery to restore use of the joint and reduce pain.
Gout
Gout is caused by a buildup of urate crystals, formed from the uric acid that’s produced when your body breaks down certain substances. People with this condition experience flares of severe pain — often in a big toe — that last for several hours. Over the following week or two, they may continue to feel discomfort in joints. The symptoms generally fade between flares, but over time they can lose range of motion.
Gout is more common in men than women and tends to develop in middle age. Flares can be triggered by diet, alcohol, certain prescription drugs, physical trauma, or illness. Treatment often involves lifestyle changes, like drinking less alcohol and exercising more, in addition to medications that fight inflammation, reduce pain, and lower uric acid production.
Psoriatic Arthritis
This type of arthritis develops in some people who have psoriasis, a skin condition that causes scaly rashes. Usually, the arthritis symptoms — pain, swelling, and stiffness in joints — start years after the skin problems first appear.
Psoriatic arthritis symptoms are often similar to rheumatoid arthritis, but this condition is more likely to result in swelling of the fingers and toes, pain in your feet and lower back, deformities in the finger and toenails, and inflammation of the eyes.
Common treatments are NSAIDs, DMARDs, and physical therapy. A drug called apremilast, which works by blocking an enzyme in the body that causes inflammation, may also be prescribed for this type of arthritis.
Putting It All Together
Arthritis conditions are a common health challenge for people on Medicare. By understanding your coverage for arthritis diagnosis, treatment, and services, you can make sure you have access to the right resources to control your symptoms. Talk to a licensed insurance agent or broker if you have questions about Medicare Advantage plans that could meet your needs.
Sources
- Arthritis Basics. CDC.
- Arthritis Disparities in People Enrolled in Medicare Fee-For-Service. CMS.
- Acupuncture. Medicare.gov.
- Considerations for Stem Cell Interventions. Arthritis Foundation.
- Osteoarthritis. CDC.