Does Medicare cover rheumatoid arthritis?

Medicare covers a variety of medications to aid alleviate rheumatoid arthritis symptoms and decrease the progression of the disease. Even with Medicare, rheumatoid arthritis therapies can be costly. You could end up paying hundreds of dollars if you don’t have additional insurance. We’ll talk about which elements of Medicare will fund Rheumatoid Arthritis therapies in this situation.

Rheumatoid Arthritis (RA) affects about 1.5 million people in the United States, and it usually strikes people between the ages of 40 and 60.



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Fortunately, rheumatoid arthritis treatment is covered by Medicare for qualifying seniors who require chronic care management services. Medicare will also assist beneficiaries with RA in covering the costs of inpatient and outpatient care.

What is arthritis?

Arthritis is swelling or inflammation of a joint (a knee, for example) or tissues around a joint, according to the CDC. Depending on what type of arthritis you have, it can affect other parts of your body as well.

What are the most common types of arthritis?

Osteoarthritis is the most frequent type of arthritis, according to the National Institutes of Health (NIH). The deterioration of cartilage between bones is known as this.Rheumatoid arthritis is another prevalent type of arthritis, according to the National Institutes of Health. This is an autoimmune illness in which your immune system destroys your tissues, including the tissues around your joints.

Gout (a buildup of uric acid crystals in the joints) and psoriatic arthritis (which can affect the skin as well as the joints) are two more prevalent types of arthritis, according to the NIH.

According to the Centers for Disease Control and Prevention, there are many different varieties of arthritis, and you can have more than one at the same time (CDC).

What is the best way to treat arthritis?

According to the CDC, there may be numerous alternative techniques to manage your arthritis depending on the type of arthritis you have and other circumstances.

Start with your doctor

The first step is to confirm that your doctor accepts Medicare or that, if you’ve purchased Medicare Part C, that your doctor is included in your plan.

Discuss the details of all recommended arthritis therapies with your doctor to determine whether they are covered by Medicare and if there are any alternative options you should consider.

Some or all of the following treatments may be used:

  • prescription drugs (OTC and prescription)
  • surgery
  • treatment (physical and occupational)
  • apparatus (cane, walker)

Is Rheumatoid Arthritis Covered by Medicare?

Medicare, in general, covers all essential therapies. However, the manner in which it is covered will be determined by the type of care you receive. Part A covers the services, treatments, and medications you get as a hospital inpatient.

This could entail joint replacement surgery or treatment for additional medical issues that occur in Rheumatoid Arthritis sufferers. Infusions, outpatient procedures, physical therapy, and other Rheumatoid Arthritis therapies are covered in Part B. However, you will be responsible for a percentage of the expense. If your arthritis is severe, Part B may cover the cost of a lift chair if it is deemed medically necessary.

Medicare covers a variety of rheumatoid arthritis treatment choices in various ways, including:

  • Medications on prescription

Rheumatoid Arthritis causes discomfort and swelling, which can be treated with several oral drugs.

Nonsteroidal anti-inflammatories are covered by many Medicare Part D prescription medication plans, as well as Medicare Advantage (Medicare Part C) plans.

  • Antirheumatic medications that treat rheumatoid arthritis (DMARDs)

DMARDs, or disease-modifying antirheumatic medications, are a type of medication that is normally given as an infusion in a doctor’s office or an outpatient hospital environment. Part B of Medicare usually covers DMARDs (medical insurance).

Biologics are DMARDs that target specific stages of the inflammatory process. These are usually injected or given as an infusion, and Medicare Part B may cover them.

You normally pay 20% of the Medicare-approved price for your DMARD therapy once you’ve met your Part B deductible ($203 per year in 2021).

  • Surgery

Joint replacement surgery may be required in some circumstances if your joints have become permanently damaged to the point of impairment. Part A (hospital insurance) of Medicare covers some of the costs of hospitalization as well as any inpatient rehabilitation that may be required.

After you’ve met your Part A deductible ($1,484 each benefit period in 2021), you could be responsible for coinsurance charges of up to $742 per day for inpatient hospital stays of more than 90 days in 2021.

  • Therapy

Physical or occupational therapy may be recommended by your doctor to maintain your joints flexible through exercise. A therapist can even show you new ways to do everyday things that are less taxing on your joints.

When a prescribing doctor deems outpatient physical therapy “medically necessary,” it is covered by Medicare Part B.

In the Medicare Program, Biologic Drugs for Rheumatoid Arthritis

If you’ve been diagnosed with Rheumatoid Arthritis, your doctor may advise you to start taking disease-modifying antirheumatic medicines, or DMARDs, right away. Biologic DMARDS can help you reduce inflammation and slow the progression of your condition. However, they are pricey.

Rheumatoid arthritis therapies may be covered by Medicare Advantage plans.

The CHRONIC Care Act of 2018 enhanced Medicare coverage for those with chronic illnesses including rheumatoid arthritis. The measure gave Medicare Advantage plans more latitude in the future when it came to covering non-medical services.

As a result of the measure, Medicare Advantage plans may now cover extra home care services and things that may be beneficial to someone with rheumatoid arthritis.

These may include, but are not limited to, the following:

  • Services for custodial caregiving (dressing, bathing, eating, etc.)
  • Meal delivery services to your home
  • Ramps for wheelchairs
  • Gym memberships for SilverSneakers

There may also be Medicare Special Needs Plans designed exclusively for rheumatoid arthritis patients. A Special Needs Plan is a form of Medicare Advantage plan that includes benefits tailored to persons who have a specific medical condition.

Advantage and Supplement Plans for Medicare

Medicare Advantage plans, also known as MA plans or Medicare Part C plans, provide all of the benefits of Original Medicare plus additional benefits in exchange for a monthly fee. Extras can include routine vision and dental treatment, as well as a reduction in Original Medicare cost-sharing responsibilities.

When you have Original Medicare, Medigap plans enhance your existing Medicare Part A and Part B benefits. For either Part A or Part B, this can cover the cost of certain deductibles or copayments. If you have RA and are on Original Medicare, you might be interested in plans that help you save money on per-visit fees if you have many health-care appointments each month.

Because these plans are provided by privately contracted insurance providers, not all of them are available in every state.

Does Medicare cover home health care?

Medicare pays for a limited amount of home health care for people who meet the following criteria:

  • You are homebound, which means it is exceedingly difficult for you to leave your house and that you require assistance to do so.
  • At least once every 60 days, you will require competent nursing or treatment services.

You must have a face-to-face meeting with a doctor within 90 days of commencing home health care or within 30 days of stopping care to qualify.

You’ll also need a doctor’s signature on a confirmation of home health certification and services from a Medicare-certified home health agency.

Medicare Part A or Part B may cover home health care benefits, which may include skilled nursing care, therapy, and care from a home health aide.

Does Medicare Cover Methotrexate for Rheumatoid Arthritis?

Rheumatrex and Trexall are two brand names for methotrexate. Because it is effective and inexpensive, it is frequently used as the initial line of defense against rheumatoid arthritis. Methotrexate may be covered under Part D, either orally or as an injectable; costs vary depending on your plan.

Does Medicare cover IVIG for Rheumatoid Arthritis?

For severe Rheumatoid Arthritis, Part B covers medically necessary intravenous immunoglobulin replacement therapy (IVIG). Coinsurance payments might be covered by a Medicare Supplement plan.

Does Medicare require a referral to see a rheumatologist?

Before paying for a specialist’s care, insurance companies frequently require a referral, which is a written order from your primary care physician. While Medicare doesn’t require referrals in most cases, certain circumstances may necessitate a special order from your primary care physician.

Assistance with expenses

A person may be eligible for additional financial assistance to cover the costs of arthritis therapy, and there are numerous choices available.

These are some of them:

  • Extra Help: Extra Help is a program that provides prescription drug coverage help. The amount of Extra Help is determined by your income and is subject to vary each year.
  • Medicaid is a state-federal program that assists people in paying for health insurance. Those who qualify may receive assistance with deductibles and drug costs.
  • MSPs are state-funded programs that assist with the payment of insurance costs such as prescriptions, premiums, coinsurance, and copayments.

Takeaway

Medically essential services and materials for the treatment of arthritis, including joint replacement surgery, will be covered under original Medicare.
Original Medicare does not normally pay out-of-pocket expenses. Depending on your needs, it may be important to look at options other than Medicare, such as:

  • Supplementary health insurance (Medicare supplemental insurance)
  • Part C of Medicare is a program that helps people with disabilities (Medicare Advantage)
  • Part D of Medicare is a supplement to the original Medicare plan (prescription drug coverage)

Does Medicare cover rheumatoid arthritis?

Does Medicare cover rheumatoid arthritis?

Does Medicare cover rheumatoid arthritis?

Mayo Clinic

Does Medicare cover rheumatoid arthritis?