Home » Blog » Healthcare Coverage for Rheumatoid Arthritis

Healthcare Coverage for Rheumatoid Arthritis

by Jagger Esch

Anyone with a chronic health condition knows it’s important to have healthcare coverage. For those with Rheumatoid Arthritis, healthcare coverage is vital.

Rheumatoid Arthritis (RA) is an autoimmune disease affecting approximately 1.5 million people in the United States. It happens to be the most common inflammatory joint disease, affecting 1-2% of the worldwide population.

The chronic inflammatory disease causes the immune system, which usually protects the body, to attack its own joints.

One of the biggest concerns for most suffering from a chronic illness is health insurance coverage. The second being out of pocket costs.

Medicare Coverage for Rheumatoid Arthritis

Looking for a health insurance plan can be a daunting experience, to say the least. Looking for a plan that includes major medical, hospitalization coverage and prescription drug benefits can be even more intimidating.

Finding a plan that’s affordable and one that meets your needs can be downright stressful! While researching Rheumatoid Arthritis coverage, you’ll want to look at the different types of insurances.

There are a variety of policies available, talking with a licensed insurance broker in your state will allow you to confidently choose which policy is most beneficial to your individual healthcare needs.

There are many different types of insurance, each offers coverage a little differently and it’s up to you to make the final decision on the best policy for you.

Coverage from a Medicare Advantage Plan

Medicare Advantage Plans will take over for Traditional Medicare benefits. They sometimes offer additional benefits like vision, dental and prescription drug coverage which isn’t normally covered with regular Medicare.

These plans contract with a group of healthcare facilities and pharmacies to provide services to beneficiaries. While premiums are generally lower, the policy limitations tend to outweigh any of the Advantage Plan benefits.

Health Maintenance Organizations aka HMO’s are the most common forms of managed care.

With most HMO policies come restrictions, such as:

  • Network of Doctors
  • Pharmacy Networks
  • Hospital Network
  • Referrals are Required
  • Limited coverage area


While this can limit who you see and what treatment you can obtain for your rheumatoid arthritis, HMO policy premiums are usually lower than other insurance types.

Another plus for HMO policyholders is there is little or sometimes no out of pocket cost for services in-network.

Medicare Advantage Private Fee-For-Service (PFFS)

This is traditional health insurance in which the policy either pays the medical provider directly or reimburses the beneficiary for services rendered.

With Private fee-for-service plans, you’re given the option to treat with the provider and facilities of your choice.

Medicare Advantage Preferred Provider Organization (PPO)

These policies are like HMO type policies; however, PPO’s offer more flexibility. There’s a list of providers you can choose, but you may also treat with, “out of network” providers.

You may have a higher out of pocket cost when treating out of network. Like HMO policies, PPO policies also require deductibles and copayments for the beneficiary.

Whether using an HMO, PPO, fee-for-service or Medicare, most plans allow treatment for autoimmune diseases.

Original Medicare Coverage for RA

Traditional Medicare offers coverage for your hospital (Medicare Part A) benefits and your outpatient care.

Whether using Part A or Part B benefits, Medicare covers treatment at 80%. The Medicare beneficiary is responsible for the remaining 20% once the policy deductible has been met.

There are additional ways in which Medicare beneficiaries can save on RA treatment.

Medicare Supplement Coverage for Rheumatoid Arthritis Treatment

A better option to consider is a Medicare Supplement Plan. These plans work in conjunction with the already excellent Medicare perks.

These policies help offset the leftover out-of-pocket costs associated with Medicare.

Deductibles, copayments, coinsurance and other out of pocket costs for any RA treatments may then be covered in full and cheaper for the beneficiary in the long run.

As rheumatoid arthritis is a chronic ailment, you’ll be looking at a lifetime of different treatment options to manage the condition.

You’ll want to make sure whichever policy you choose will benefit you for the foreseeable future.

Medicare Coverage for RA Treatment

Thanks to the Affordable Care Act passed in 2010, the comprehensive health care reform law has made health insurance more affordable to Americans.

Another added benefit is that you cannot be denied health insurance coverage for pre-existing rheumatoid arthritis. Additionally, your carrier cannot drop your coverage if you were to develop RA while already insured.

For those suffering from rheumatoid arthritis, this means insurance coverage will include:

  • Disease management
  • Emergency Room visits/ hospitalizations
  • Preventative care
  • Counseling for weight loss and nutrition
  • Mental health services


Those individuals with Medicare, Medicaid or who have insurance through a workplace, the same above benefits apply. This is good news for those with RA as most treatment options will be covered.

Things to Consider Before Buying Insurance

You can contact your individual healthcare provider or insurance carrier to see exactly what RA treatment options are covered. They should also be able to discuss any potential out of pocket costs to you.

Some key facts to consider when searching for insurance include:

  1. Make sure there is prescription drug coverage. RA medications, especially IV infusions and Biologics can be costly. Without proper prescription benefits, the out of pocket costs can be extortionate.
  2. Benefits that cover occupational and physical therapy. Therapy has been proven to help prevent joint pain and further damage caused by RA.
  3. Access to specialists. Once diagnosed with RA, it’s crucial to establish with a rheumatologist to start beneficial treatments. Proper care is essential to maintain your disease and to prevent further joint deformity


While having rheumatoid arthritis can be overwhelming, getting treatment shouldn’t be. With the ever-changing healthcare system and evolving treatment options, insurance coverage is more important than ever.

Care is available for RA and the sooner you start treatments, the better and more manageable the disease will be!

You may also like

Leave a Comment