ORIGINAL MEDICARE
By the time most people enter the age to be eligible for Medicare coverage, they’ve experienced at least some type of lumbar, or lower back, pain. The usual age of eligibility is 65, however, certain people may qualify for Medicare benefits earlier.
There’s many treatment options including:
- Physical Therapy
- Chiropractic Treatments
- Medications
- Injection Based Treatments
- Surgical Intervention
If you’re a Medicare beneficiary experiencing lower back pain for one reason or another, it’s important to know what treatments and pain management therapies are covered. The cause of the back pain will determine what type of treatments and pain management therapies a patient is eligible for.
Common Conditions of Lower Back Pain
Sciatica
Most people have heard the term “Sciatica” at some point. But did you know this term is oftentimes used incorrectly to explain lower back pain?
Those experiencing pain stemming from the Sacroiliac joint, or SIJ, have true Sciatica. The SIJ joint connects your hip to your spine. When the SIJ becomes inflamed from irritation or Arthritis, it can cause Sciatic pain.
Disc Herniation
The outer portion of the vertebral disc contains the cushioning between the vertebral bodies of the spine. A disc herniation is a condition in which the outer portion of the vertebral disc is torn. This tear causes the inside, commonly referred to as the nucleus, to extrude through it’s fibers at a certain level. This condition can replicate Sciatic pain.
Lumbar Stenosis
Lumbar Stenosis can be categorized as either Arthritis or narrowing of the spaces within the spine. This condition affects the surrounding nerves which then in turn can also replicate Sciatic pain.
Facet Joint Arthropathy
The Facets are the joints extending from the spine that provide support and allow movement. Facet Joint Arthropathy refers to the degenerative disease that breaks down the cartilage around these joints.
Other common terms for Facet Joint Arthropathy is Facet Joint Arthrosis or Facet Joint Osteoarthritis. Depending on what level of the Facet joint is affected, it can cause referred pain which can mimic Sciatic pain.
Lumbar Spondylolisthesis
Lumbar Spondylolisthesis is the movement, or slipping, of the vertebral body. This can cause both pain and compression of the nerve, which can also mimic Sciatic pain.
Interventional Pain Management for Lower Back Pain
Interventional Pain Management is to proceed with conservative treatments vs surgical invention. In simple terms, it means to manage the symptoms of your specific condition in order to avoid more invasive treatment methods.
There are two types of pain management physicians:
- Non-interventional: those willing to mask the pain with strong opioid pain medications
- Interventional: those whose sole purpose is to help patients relieve their pain beyond medication
Why Avoid Surgical Intervention
While some individuals may require surgery, others consider it a last resort for many reasons. There’s no guarantee that surgery will provide pain relief. Unless an Orthopedic or Neurosurgeon can guarantee you over 50% improvement, you want to avoid surgery at all costs.
Additionally, with any surgery including the lumbar spine, there’s always the risk of complications or worsening of the of the original condition. You really want to consider surgery as a very last resort, meaning you have tried and failed all conservative treatments, including Interventional Pain Management.
Interventional Pain Management Injections Covered by Medicare
Per the typical Medicare guidelines, most, if not all, cortisone injections are covered without needing prior authorization. Different injections have different costs. Make sure to ask your medical provider what the Medicare allowables are for each procedure.
Remember, Medicare only covers 80% of approved medical services. Leaving the remaining 20% up to the beneficiary to pay, as well as additional out of pocket costs such as deductibles, coinsurance and copayments.
That’s why Medicare secondary insurance, or a Medigap Plan, is crucial for those with lower back pain issues. Whether you’re undergoing Interventional or Non Interventional Pain Management treatments, Medicare secondary insurance will protect you financially and give you peace of mind.
There are many different types of injections that can be utilized as treatment for those with either chronic or acute conditions including:
- SIJ injections: These are therapeutic injections in which cortisone is injected directly into the joint.
- Lumbar Facet Injections: These are therapeutic injections in which cortisone is injected directly into the joints.
- Lumbar Medial Branch Blocks: This is a diagnostic procedure in which Lidocaine is used to “test” the affected joints nerve endings to see if one responds with pain relief. If the patient experiences relief, this tells the physician the correct nerves were targeted, therefore they are a candidate for a Radiofrequency Ablation.
- Radiofrequency Ablation or RFA: A therapeutic procedure in which the affected nerves have been identified from the Medial Branch Blocks (or MBB’s) and are then cauterized for long lasting relief.
- Lumbar Epidural Steroid Injection: This is a therapeutic injection in which cortisone is injected around the affected disc and nerve endings for pain relief.
How do Cortisone Steroid Injections Help with Lower Back Pain
Cortisone is a strong synthetic anti-inflammatory that is injected into a specific area of the body. It helps reduce inflammation, which in turn helps to decrease pain.
For more help on how to beat back pain, you can check out 53 Health & Fitness Experts Tips where 53 experts, including us, shared their top tips.
Where to Get Help with Lower Back Pain Management Costs
The benefits of a Medicare Supplement/Medigap plan varies, depending on which letter plan you choose. We can help guide you to find the best plan possible for all your individual needs. Click or call today, our agents are here to help and our services are 100% free. You can also compare rates online now here.
My Dr. said I have sciatica and some arthritis after viewing my Mir and that I need to see an orthopedic/neurologist Dr. About surgery. Am I covered?
Hi Lynne! Assuming you have Original Medicare, your Part B will cover 80% of your medical costs at the orthopedic/neurologist. If you have a Medicare Supplement Plan, the remaining 20% will also be covered. If you have Plan F or Plan C, your Part B deductible will also be covered. If you don’t have a Medicare Supplement Plan, you’ll be responsible for the remaining 20% Medicare doesn’t cover, as well as the Part B deductible.