Rheumatoid Arthritis and Medicare… What Do You Need to Know?

Medicare and Rheumatoid Arthritis, TMA Blog

Managing your Rheumatoid Arthritis within the Medicare system can seem complicated and worrisome. Medicine costs and treatment plans are expensive and can change based on the progression of your disease. Instead of spending your time worrying about Medicare, we want to help you find the freedom to just focus on your health. Let us show you why taking a second glance at your Medicare plan could be beneficial in reducing the costs associated with your Rheumatoid Arthritis.

Understanding Rheumatoid Arthritis and Medicare

Monthly costs of treatments for your Rheumatoid Arthritis can sometimes rack up anywhere between $1,300 to $3,000 per person. Having been dealing with Rheumatoid Arthritis and Medicare, many of you might have already discovered that medications and treatments for this ailment can greatly vary depending on the severity of symptoms. Most times only part of the drugs and treatments you need are covered, which can be confusing. Similarly, physical therapy and surgery costs can become quickly overwhelming. So, what specifically is covered for your Rheumatoid Arthritis by Medicare?

Are my office visits covered?

Both Medicare Parts B and C can cover up to 80% of the cost of doctor’s office visits, as well as most drugs administered in the clinical setting. How is the remaining 20% covered, though? We recommend that you consider looking into a Medigap plan.

Medigap plans, which are also called Medicare Supplement Plans, or Med Supp, provide extra insurance that helps you pay your Original Medicare out-of-pocket costs. These costs, such as co-insurance and deductibles, are called “gaps” in medical coverage. These supplemental Medigap plans can help cover the cost of the extra 20% not covered by Original Medicare, which becomes incredibly critical once you realize this 20% accounts for potentially thousands of dollars.

If I need surgery, is it covered?

If your doctor recommends receiving joint surgery, Part A will cover hospitalization for the procedure. This means that the inpatient rehabilitation costs will be covered through your Medicare plan. For those of you with a Medicare Advantage Plan, or Part C, the surgery costs are also covered. However, Part C plans are privatized, so in order for your costs to be covered, the doctors you see must be within your healthcare network. So, if your primary care doctor recommends you to a surgeon or specialist, double check that the specialist recommended is within your network to avoid unexpected costs.   

Are my medications and treatments covered?

Nearly all Part C plans cover medication costs, though this is dependent on the specific type of plan you have. If you aren’t sure and would like a free Health Insurance Review, please contact us today. If you think you may soon need Disease-Modifying Antirheumatic Drugs (DMARDs) or Biologics, keep in mind these generally do not fall under Part D of Medicare. The reason is that most are taken at the doctor’s office which means these drugs will be covered by Medicare Part B.

Part D coverage is useful in helping pay for your prescription drugs that aren’t already covered by Part B. As you know, Rheumatoid Arthritis medications tend to become extremely pricey (Biologics alone can cost up to $20,000 a year). While NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and aspirin can be bought cheaply over the counter, other drugs like Biologics (Humira and Kineret), Steroids (Cortisone and Prednisone), and DMARDs (Trexall and Arava) can become significantly more expensive when not covered by your Medicare plan. In short, it’s incredibly beneficial to have a Part D plan when you have Rheumatoid Arthritis and Medicare.

It’s vital to ask your doctor about medication and where they should be taken because the difference can greatly impact the amount you pay in copays and deductibles. For example, receiving a prescribed injection at the doctor’s office can cost substantially less than getting the exact same medication prescribed to take at home. It’s crucial to have transparent communication with your doctor to make sure you aren’t paying any more than you must. Remember: your doctor is there to answer your questions, but it’s up to you to ask them.

Consequently, consulting with one of our licensed representatives can help make sure you don’t get caught up in the doughnut hole (a gap in coverage in Plan D) which can lead to more out-of-pocket costs than you were expecting.

Finding the best Medicare plan for you!

Because of the complexity of Medicare and the varying levels of treatment for your condition, finding a cost-effective plan on your own may seem impossible. You may feel understandably frustrated managing your Rheumatoid Arthritis and Medicare. But we can help bring you peace of mind.

Contact a licensed representative about specific plans in your area. Together, we can find the best plan to fit your needs!


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