The Ultimate Guide to Medicare Coverage for Arthritis
November 18, 2019
Reviewed and Updated by Troy Frink,
Arthritis is an inflammation of the joints. The condition can affect one or more joints, and it can cause pain and stiffness. According to the Centers for Disease Control and Prevention (CDC), approximately 54.4 million adults 18 and older have diagnosed arthritis, and the “prevalence of arthritis increases with age.”
Some types of arthritis may be preventable and the symptoms may be manageable. Medicare may cover different treatments and services for arthritis.
Common Types of Arthritis
There are more than 100 types of arthritis, but the most common types are:
Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune condition in which the immune system attacks your joints and organs. Rheumatoid arthritis has no known cause. According to the Mayo Clinic, your primary care provider may refer you to a rheumatologist if you have the following symptoms:
- Tender, warm, and/or swollen joints
- Stiff joints that are worse in the morning or periods of inactivity
- Fatigue
- Fever
- Loss of appetite
To diagnose rheumatoid arthritis, your rheumatologist may perform:
- Blood tests
- Inflammation tests such as erythrocyte sedimentation rate (ESR)
- Rheumatoid Factor (RF) tests to look for antibodies that indicate rheumatoid arthritis
- Imaging tests such as X-Ray, MRI, and Ultrasound to examine joints
Medicare Coverage for Rheumatoid Arthritis
Original Medicare helps cover doctor-recommended diagnostic testing for RA, doctor’s appointments, and some doctor-administered drugs such as disease-modifying antirheumatic drugs (DMARDs). Other covered treatments can include physical therapy, over-the-counter (OTC) drugs such as ibuprofen, and corticosteroids (inflammation relief drugs) such as prednisone. In rare circumstances, your doctor may recommend surgery.
Original Medicare does not cover prescription drugs that you take at home, but Medicare Part D or certain Medicare Advantage plans might.
Medicare Advantage plans are private insurance plans that can cover benefits Original Medicare does not such as meal delivery, OTC drugs, and non-emergency medical transportation.
Osteoarthritis
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), osteoarthritis is the most common type of arthritis. The disease causes damage to a joint’s protective cartilage, which wears down over time. Osteoarthritis can affect any joint, but it most commonly occurs in the hands, knees, hips, and spine.
Risk factors include:
- Being overweight
- Age
- Joint injury
- Joints that are not properly formed
- A genetic defect in joint cartilage
- Joint stress caused by repetitive physical activity (sports, active jobs, etc.)
Osteoarthritis can have the following symptoms:
- Joint stiffness, especially after sitting for long periods of time
- Swelling or tenderness in one or more joints
- The feeling of bone on bone, or a “crunching” feeling
Osteoarthritis Treatment and Medicare Coverage
Treatment for osteoarthritis includes over-the-counter drugs such as Tylenol and ibuprofen. Prescription-drug treatment can include antidepressants such as Cymbalta, which can ease arthritis-related pain if OTC drugs don’t work. Medicare Part D and certain Medicare Advantage (MA) plans can cover prescription drugs, and some MA plans may cover OTC drugs.
Medicare Part D and MA plans can also cover cortisone injections and hyaluronic acid (HLA) injections.
Non-medication treatments can include physical therapy, occupational therapy, and if the condition becomes severe, surgery such as osteotomy and joint replacement.
Psoriatic Arthritis
Psoriatic arthritis is an autoimmune condition like rheumatoid arthritis. Like rheumatoid arthritis, psoriatic arthritis can cause joint stiffness and pain. According to the Arthritis Foundation, about 30 percent of people who have the skin condition psoriasis also get psoriatic arthritis.
Symptoms of psoriatic arthritis include:
- Joint pain and stiffness
- Tendon or ligament pain
- Rashes or changes to fingernails and toenails
- Fatigue
- Limited range of motion
- Vision problems
Psoriatic arthritis is also linked with irritable bowel syndrome (IBS), Crohn’s disease, and other digestive issues such as diarrhea.
Medicare Coverage for Psoriatic Arthritis
Psoriatic arthritis treatment includes prescription drugs such as DMARDs and corticosteroid injections, and topical treatments such as calcipotriene. Over-the-counter treatments include topical treatments such as salicylic acid gel and NSAIDs.
Other Original Medicare-covered treatments can include light therapy and physical therapy.
Fibromyalgia
Fibromyalgia is a condition that causes chronic pain, fatigue, memory problems, and changes in mood. It is not one disease, but a collection of manageable symptoms. The cause is unknown. Symptoms include:
- Pain: The most common fibromyalgia symptom is widespread pain in the joints, bones, and muscles.
- Fatigue: Many people with fibromyalgia experience exhaustion, flu-like fatigue, and/or disturbances to sleep.
- Problems with concentration and mood: Depression is a common symptom of fibromyalgia, along with difficulty concentrating or performing simple mental tasks. Stressful times often exacerbate these symptoms.
- Headaches: People with fibromyalgia often experience tension headaches and/or migraines.
Fibromyalgia Treatment
Treatment for fibromyalgia does not cure the condition, but it helps manage symptoms.
According to the Arthritis Foundation, “There are currently three FDA-approved medications for fibromyalgia –– pregabalin, duloxetine and milnacipran.” Some Medicare Part D and Medicare Advantage plans may cover those drugs.
Other treatments can include exercise, acupuncture, and biofeedback, which teaches people how to change physiological functions such as slowing a rapid heart rate.
Gout
According to the Arthritis Foundation, “Gout is a form of inflammatory arthritis that develops in some people who have high levels of uric acid in the blood.” Gout usually starts in the big toe or a joint in the lower body. Gout usually starts after an illness, injury, or infection, and it affects one joint at a time.
Gout Treatment
According to the Arthritis Foundation, gout treatment includes medication and “lifestyle changes.”
Prescription drugs to treat pain and inflammation include colchicine and corticosteroid injections. Drugs to reduce uric acid include Zyloprim and Uloric. OTC medications include NSAIDs.
If you have a gout flare-up, you should take anti-inflammatory medication, ice and elevate the joint, stay hydrated (but not with sugary soda), relax, and ask for help to perform daily tasks.
Get Medicare Coverage for Arthritis Today
If you need help getting Medicare coverage for arthritis, an agent with Medicare Plan Finder can help. Our agents can help determine your budget, lifestyle, and medical needs, and search for a plan in your area that suits you. To set up a no-cost, no-obligation appointment with a licensed agent, call 1-844-431-1832 or contact us here today.
