By What Osteoarthritis Treatments Does Medicare Cover?
Osteoarthritis is a common degenerative joint condition that affects millions of older adults in the United States. Managing osteoarthritis often requires a combination of medical treatments, therapy, and, in some cases, surgical intervention. Medicare covers many osteoarthritis-related treatments, but beneficiaries should be aware of potential deductibles and out-of-pocket costs. This article outlines the latest Medicare guidelines on osteoarthritis treatments and their associated costs.
Medicare-Covered Osteoarthritis Treatments
Doctor Visits and Specialist Care
Medicare Part B covers necessary doctor visits, including consultations with primary care physicians, rheumatologists, and orthopedic specialists. After meeting the annual Part B deductible ($257 in 2025), beneficiaries are responsible for 20% of the Medicare-approved amount for services, while Medicare pays the remaining 80%.
Medications
Prescription medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can help manage osteoarthritis symptoms. Medicare Part D (Prescription Drug Plan) or Medicare Advantage plans with drug coverage help cover the costs. Each plan has its formulary, so beneficiaries should check if their prescribed medication is covered and the copayments.
Physical and Occupational Therapy
Physical therapy can help improve joint function and mobility. If deemed medically necessary, Medicare Part B covers outpatient therapy services, including physical and occupational therapy sessions. After the Part B deductible is met, patients pay 20% of the Medicare-approved amount for each session.
Durable Medical Equipment (DME)
For individuals who require mobility aids, Medicare Part B covers durable medical equipment, such as walkers, braces, and canes, if prescribed by a doctor. After the deductible is met, coverage follows the 80/20 cost-sharing structure.
Joint Injections and Pain Management
If deemed medically necessary, Medicare covers joint injections such as corticosteroid and hyaluronic acid injections. However, coverage for hyaluronic acid injections varies, and prior authorization may be required. Costs are subject to Part B deductibles and 20% coinsurance.
Surgical Procedures (Joint Replacement Surgery)
If non-surgical treatments fail to relieve, Medicare covers joint replacement surgery, including knee, hip, and shoulder replacements.
- Inpatient Surgery: Medicare Part A covers hospital stays related to joint replacement surgery. The 2025 deductible for inpatient care is $1,676 per benefit period.
- Outpatient Surgery: If performed as an outpatient procedure, Medicare Part B covers the surgery, with a 20% coinsurance after meeting the deductible.
Read More: Understanding Medicare Part A and Part B: The Foundation of Original Medicare
Chronic Care Management (CCM)
Medicare offers chronic care management services under Part B for individuals with multiple chronic conditions, including osteoarthritis. These services involve personalized care plans, provider coordination, and ongoing monitoring. A monthly copayment may apply.
What Medicare Does Not Cover
- Acupuncture: Medicare only covers acupuncture for chronic lower back pain, not for osteoarthritis.
- Stem Cell Therapy: Experimental treatments, including stem cell therapy, are not covered.
- Over-the-counter Medications and Supplements: Medicare does not cover supplements such as glucosamine and chondroitin.
Final Considerations
While Medicare provides substantial coverage for osteoarthritis treatments, beneficiaries should always verify coverage details with their specific plan provider. Out-of-pocket costs can vary based on plan selection, copayments, and deductibles. For additional assistance, it is recommended that beneficiaries contact Medicare (1-800-MEDICARE) or review the latest Medicare guidelines online.
