Does Medicare Cover Knee Gel Injections? 

There’s no question that people lose flexibility with age, but you may actually be surprised to learn that conditions like osteoarthritis can affect up to 50% of Americans over the age of 65. According to the Centers for Disease Control, women in this demographic are more likely to develop osteoarthritis, but both genders can be affected.

Symptoms of osteoarthritis, sometimes simply referred to as arthritis, include joint stiffness, loss of flexibility, pain on movement and swelling. Osteoarthritis is not to be confused with rheumatoid arthritis, a condition caused by an overactive immune system that attacks the joints. Osteoarthritis occurs due to wear and tear on the joints over time, ultimately leading to a loss of cartilage that results in reduced range of motion.

What treatments are available for osteoarthritis?

Treating osteoarthritis may require a combination of therapies. For mild osteoarthritis, over-the-counter pain relievers and anti-inflammatory medications may be enough. Surgery is a last resort and is only an option when joint replacement is necessary.

For most seniors, osteoarthritis symptoms can be managed by making lifestyle adjustments, including losing weight and exercising, but physical therapy may help as well. Another potential solution is receiving gel injections, most commonly administered in the knees.

What are knee gel injections?

Knee gel injections, also known as hyaluronic acid injections, are osteoarthritis treatments that involve injecting a gel-like substance into knees affected by osteoarthritis. This substance acts as a cushion for joints that have lost cartilage due to osteoarthritis. The effectiveness of knee gel injections varies, but most seniors are able to receive relief for around six months after an injection of hyaluronic acid. Afterward, follow-up injection appointments may be required.

Does Medicare cover knee gel injections?

Seniors eligible for Medicare benefits can receive coverage for knee gel injections every six months when ordered by a Medicare-participating physician. Prior to Medicare coverage being applied to knee gel injections, diagnostic imaging must be completed. This is usually done by having simple x-rays taken. Your doctor’s office visit and x-rays, when ordered by a provider who accepts assignment, may be covered by Medicare Part B. 

How does Medicare cover knee gel injections?

Medicare Part B is the most common part of Medicare benefits used to pay for knee gel injections. Outpatient insurance through Medicare Part B pays for 80% of approved expenses, but Medicare recipients will need to maintain coverage by paying a monthly premium. Medicare Part B also requires you to meet an annual deductible before benefits apply. This amount is  $240 in 2024, meaning you will need to pay $240 worth of outpatient expenses before Medicare benefits begin paying for outpatient costs.

Medicare Part A

Medicare Part A, the inpatient benefit, may cover the full cost of knee gel injections if they are administered while you are hospitalized or admitted to a skilled nursing facility (SNF). The facility must participate in Medicare, and you must be officially admitted in order for your medical expenses to qualify for Medicare Part A coverage. Simply visiting a hospital for treatment does not qualify as inpatient care. While Medicare Part A covers the full cost of all treatments provided by an inpatient facility during an admission period, the program only offers this full coverage for 60 days in a hospital or 20 days in an SNF per benefit period.

Medicare Part D

If you are prescribed the use of medications in conjunction with knee gel injections, Medicare may pay for prescription drugs through Medicare Part D. You must enroll in a Part D plan in order to receive coverage for prescription drugs. Part D enrollment is not automatic when signing up for Original Medicare. Each plan will cover a wide range of select drugs. You can find out which medications are covered by reviewing your plan’s formulary. Costs and benefits can vary among Part D plans. 

Does Medicare cover joint replacement surgery?

If knee gel injections are not enough to resolve your osteoarthritis and joint replacement surgery is required, Medicare benefits may help pay for your procedure. Medicare Part B pays for medically necessary outpatient surgeries, and once again, Medicare recipients pay a 20% coinsurance for expenses. If you are hospitalized and surgery is ordered during your inpatient admission, Medicare Part A supplies benefits.

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