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Rheumatoid Arthritis (RA) can be a painful condition for many Medicare beneficiaries across the U.S. Every part of Medicare covers certain RA services and treatments. Many of the services and treatments will fall under Medicare Part B. Your specialist doctor appointments and your pain management plan, which can include services like physical therapy or lab work, are covered by Part B. It can seem scary to have this chronic condition and wonder if Medicare will deny a healthcare service. So, let’s walk through all you need to know about Medicare coverage while dealing with arthritis.

Medicare Coverage and Arthritis

Unfortunately, there is no cure for Rheumatoid Arthritis. Thankfully, various treatments and medications can help manage the pain this disease causes and slow its progression. The type of care you’d need to treat this condition will be a variety of services and medicine. Most of these will be services and treatments covered under Medicare Part B or prescription drugs.

Medicare Part B treatments

Medicare Part B covers your outpatient services. If you have RA, you will likely get lab work and imaging done to see if there have been any changes to your body as it fights this disease. Medicare Part B will also provide coverage if your provider deems physical therapy medically necessary. Part B pays 80% of the costs of these types of services.

While many of the drugs prescribed to RA patients get picked up at the pharmacy, there are some cases where you would receive treatment in a clinical setting. In this case, your treatment would fall under Part B. For example, a medically necessary steroid shot for RA pain would get covered by Part B.

Arthritis and Medicare Part D

Medicare Part D covers your prescription drugs. A lot of the medications for arthritis you pick up at the pharmacy and take at home. The good thing is most of these drugs are covered by your prescription plans. Depending on how your plan works, you will have various copays, deductibles, or coinsurance amounts to pay.

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Medicare Part A coverage

If your healthcare provider recommends surgery, like joint replacement, Medicare Part A will cover your hospital stay and any rehab services your doctor order after the surgery. If you only have Medicare Part A and B, you would first need to pay the Part A deductible ($1,556 in 2022) before it provides coverage for your inpatient stay.

Arthritis and Medigap Plans

Although Medicare can provide coverage for RA treatment, it can quickly add up. Many Medicare beneficiaries with a chronic condition like RA like to enroll in a Medigap plan to help cover the remaining 20% Part B doesn’t pay.

Many of these plans provide coverage for the Part A deductible, coinsurance, and copays. An important thing to note about these plans is that as long as Medicare approves and pays for a service, your Medigap plan will pay too.

Medicare Advantage and Arthritis

A Medicare Advantage plan could be another option if you want more coverage than Medicare alone. Some of these plans have prescription coverage that offers lower copays and coinsurance than Original Medicare.

Unlike Medicare’s unlimited 20% out of pocket, every Advantage plan has a maximum out-of-pocket, so at least you know your arthritis treatments and services will never exceed a certain amount. Remember that these plans have a network of providers, so you would need referrals and sometimes prior authorization to see specialists and receive the treatment you want.

Managing Arthritis under Medicare

Medicare denying treatment is the last thing you want to worry about when dealing with arthritis pain. A positive is that Medicare tends to cover most treatments and services for rheumatoid arthritis when medically necessary. It’s important to have trustworthy healthcare providers to help you manage your condition. Having additional coverage like a Medicare Supplement or Medicare Advantage plan can help reduce your out-of-pocket spending so you can focus on getting the care you need to live your life as pain-free as possible.