Medicare and Arthritis: What's Covered and What's Not?

Health Line

12 hours ago

Key takeaways
Original Medicare (parts A and B) will cover services and supplies for arthritis treatment if your doctor has determined it's medically necessary.
Medicare won't cover over-the-counter (OTC) medications that your doctor may recommend for managing osteoarthritis symptoms, such as acetaminophen (Tylenol) and OTC nonsteroidal anti-inflammatory drugs (NSAIDs), like naproxen sodium (Aleve) and ibuprofen (Motrin).
To determine whether your treatment is covered, your first step is to make sure that your doctor accepts Medicare or, if you've purchased Medicare Advantage (Part C), that your doctor is on your plan.
There are many types of arthritis. Among the most common are osteoarthritis and rheumatoid arthritis.
Does Medicare pay for arthritis?
Generally speaking, the answer is yes in many cases.
The following are examples of specific arthritis treatments that Medicare may cover:
medications such as corticosteroids, biologics, or disease-modifying antirheumatic drugs (DMARDs)
physical therapy
surgery, such as total knee replacement and osteotomy
assistive devices like knee braces
pain management
However, Medicare coverage is divided into several parts, so your coverage can vary depending on the exact treatment you need.
Which parts of Medicare cover arthritis?
Original Medicare includes parts A and B. Part A covers inpatient hospital stays and skilled nursing care. This may include surgery.
On the other hand, Part B covers outpatient medical costs such as doctor's visits and durable medical equipment (DME). DME can include things like splints or canes, but you require preauthorization to get coverage.
Under Part B, you also get pain management coverage. In addition, you can get chronic care management if you live with two or more chronic conditions that you expect to manage for at least a year or longer. This can apply if one of those conditions is arthritis. This coverage will pay for a doctor to manage your care.
Part D, on the other hand, covers all or part of the costs of specific prescription drugs. Not all medications are covered, so confirming coverage is a good idea to help avoid unexpected costs.
Medicare Advantage
Medicare Advantage (Part C) combines Original Medicare coverage with some added benefits.
These plans include Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) and may offer Medicare Part D. Some may include extra coverage such as dental, vision, hearing, and wellness programs, as well as Special Needs Plans (SNPs).
Medigap
Lastly, there is Medigap, a supplemental plan that helps cover out-of-pocket costs like deductibles and coinsurance. It is administered by private insurance companies under Medicare's rules. Depending on what you need, it may provide additional coverage.
Note that you cannot have Medigap and Part C, so you must choose one or the other.
What's not covered
Medicare won't cover over-the-counter (OTC) medications that your doctor may recommend for managing osteoarthritis symptoms, such as:
How much does Medicare cost if you have arthritis?
The costs of Medicare Part D, Medigap, or Medicare Advantage vary by plan. With Original Medicare, the costs are as follows:
Part A
You usually don't have a premium if you're hospitalized for an arthritis-related procedure.
However, some people may not qualify for premium-free coverage. In this case, you'll pay either $285 or $518 monthly, depending on how long you or your spouse have worked and how long you've paid Medicare taxes.
You'll also have a $1,676 deductible, after which Part A will kick in full for 60 days of hospitalization. You will incur additional costs if you need to stay in a hospital or a skilled nursing facility longer.
Part B
In 2025, for most people, the premium is $185.00. You'll also probably pay $257 for your annual Part B deductible. After the deductible, you typically pay a 20% copay of Medicare-approved amounts for:
most doctor services (including as a hospital inpatient)
outpatient therapy
DME, such as a walker or wheelchair
Frequently asked questions
At what point does arthritis become a disability?
This depends on the type of arthritis you have and your symptoms. Generally, the condition can qualify as a disability under Social Security as an immune system disorder if you haven't been able to work for at least 12 months.
Learn more: ' When Is Arthritis a Disability? '
What benefits can I claim with arthritis?
In addition to financial benefits, getting disability benefits means you'll qualify for Medicare coverage before the age of 65 years.
Learn more: ' Can You Get Medicare If You're Under 65? '
Takeaway
To determine whether your treatment is covered, your first step is to make sure that your doctor accepts Medicare or, if you've purchased Medicare Part C, that your doctor is on your plan.
Discuss the specifics of all recommended arthritis treatments with your doctor to see if your Medicare coverage covers it or if there are other options you may want to consider.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.