As an autoimmune and systemic disease, Rheumatoid Arthritis (RA) can impact the way every organ functions. If you’ve been diagnosed with RA, you may need care provided by a spectrum of specialists and services. Different parts of your Medicare benefits may be used to cover costs associated with your treatment for RA.
Medicare Part A and Rheumatoid Arthritis
Original Medicare Part A, often called hospital insurance, kicks in when you’ve been admitted as an inpatient for a hospital stay. This may occur if you need surgery to treat a health issue caused by RA, like a joint replacement. Surgeries related to RA may also require rehabilitation in a skilled nursing facility (SNF). SNF services are also covered by Part A Medicare benefits.
Most Medicare beneficiaries do not pay a monthly premium for Part A benefits. Recipients are responsible for their share of costs, such as meeting the Part A deductible and paying a 20% coinsurance for allowable services.
Medicare Part B and Rheumatoid Arthritis
Medicare Part B, or the medical insurance part of the Original Medicare program, helps recipients pay for preventative and specialist services rendered in an outpatient setting. This may even include home health care services for certain medically necessary procedures that must be performed by a health care professional.
Most prescription medications are not covered by Part B benefits, but some RA-specific treatments that use prescription drugs in an outpatient facility may fall under Part B policy. In this case, recipients pay their portion of the cost — this includes keeping up-to-date with their monthly premiums, meeting the deductible and satisfying any relevant coinsurances or copayments for a service.
Medicare-certified health care professionals typically agree to charge certain rates for certain services, but Medicare can allow a professional to bill a patient for excess charges. Treatment for RA can involve expensive procedures or medications, so recipients may be at an increased chance of accruing excess charges. Your health care professional can help you plan for this if it comes up.
Medicare Part D and Rheumatoid Arthritis
A variety of prescription medications have been developed to help treat and manage symptoms associated with RA. Many brand name drugs also have cheaper generic versions, as well.
Original Medicare does not cover most prescription drugs, but Medicare Part D plans in your area may offer a lot of options for RA prescription drug coverage. Medicare Part D formularies arrange drugs into tiered categories according to their cost and the copay expected from the recipient.
These prescription drug plans are sold as standalone programs that can be purchased alongside Original Medicare and Medigap plans, but they can also be part of a Medicare Part C bundle, too.
Part D prescription drug coverage usually sets yearly limits on how much coverage the plan offers. Recipients with an RA diagnosis may be prescribed many different types of medication, which means they may reach this yearly limit quickly. After the limit is reached, out-of-pocket costs may increase until catastrophic coverage terms can begin.
Medicare Advantage and Supplement Plans
Medicare Advantage plans, which can also be called MA plans or Medicare Part C plans, offer everything Original Medicare does and stacks extra benefits on top of it for a monthly premium. Extras can include routine vision and dental care, or the cost-sharing obligations associated with Original Medicare may be reduced.
Medigap plans supplement existing Medicare Part A and Part B benefits when you have Original Medicare. This can cover the cost of certain deductibles or copayments for either Part A or Part B. Recipients with RA with Original Medicare may be interested in plans that help them save on per-visit costs if they anticipate multiple health care appointments each month.
These plans are offered through privately contracted insurance carriers, which means not every plan is available in every state.
What Are My Options During the Medicare Advantage Open Enrollment Period?(Opens in a new browser tab)
Will a Medigap Plan Give Me Prescription Drug Coverage?(Opens in a new browser tab)