The Medicare-covered alternative to knee replacements could include therapy, injections, or Durable Medical Equipment. Medicare may cover other knee replacement alternatives.
By the time most seniors are Medicare eligible, they’ll have joint pain. Treatment for joint pain can be conservative care to highly invasive surgical procedures.
Here we discuss alternative treatment options for those suffering from knee pain and avoiding knee replacement surgery.
Does Medicare Cover Knee Replacement Alternatives
In some cases, DME requires prior authorization; however, an RX from your medical provider is generally sufficient.
Different injections have different costs, ask your provider about Medicare allowable amount for each procedure.
Is There a Medicare Knee Replacement Age Limit
No, there is no age limit placed by Medicare for knee replacements. The majority of patients undergoing knee replacement are between 50 and 80 years old; although, orthopedic surgeons will evaluate each individual.
Of course, you must be on disability for at least 2 years or 65 years old to receive Medicare.
Arthritis pain is one of the most common diseases for elderly patients. There are many types of arthritis; however, osteoarthritis (OA) is the most common affecting millions of seniors over the age of 65.
Since osteoarthritis is a degenerative disease, the arthritis symptoms, and the condition itself worsen with age. So, what is osteoarthritis you ask? Osteoarthritis is when cartilage deteriorates.
Medicare will provide you with some coverage if eligible.
Does Medicare Pay for Knee Gel Injections
Medicare covers hyaluronan injections for knee pain due to osteoarthritis only. The coverage is good for one injection every 6 months.
Hyaluronan is Hyaluronic Acid, it’s naturally occurring in the body. While this solution may not be best for everyone, it should be something to consider before resorting to a knee-replacement.
This treatment is Viscosupplementation.
Does Medicare Cover Rooster Comb Injections
This treatment method only has FDA/ Insurance approval for the knees. Although, studies are underway for this to treat other joints such as the hip, shoulder, and elbows.
Treatment with this method is Viscosupplementation.
It’s when the knee is bone on bone, a natural supplementation from a rooster’s comb, hyaluronic acid injections provide cushioning. It acts like a lubricant preventing the bones from rubbing together and in turn decreases pain.
These injections can prevent or at least prolong knee replacement. Most patients experience pain relief for about 6 months.
Does Medicare Cover Synvisc Injections or Hyalgan Injections
As far as Synvisc goes, this is an out of the pocket procedure. The FDA hasn’t given approval for the treatments for interventional pain management.
Synvisc-One injections might not have Medicare coverage, even with a doctor request. Of course, Medicare does offer reimbursement for Synvisc-One and SYNVISC.
With a Medigap policy, they will cover the remaining 20%.
Hyalgan injections are another brand name like Synvisc; coverage for Hyalgan is available through many insurance plans, including Medicare. Since it’s given in the doctors’ office and the doctor administrates the injection, coverage is under Medicare Part B.
Does Medicare Cover iovera°
Receiving Medicare coverage for iovera° will depend on your circumstances. Your physician can help you create a proper care plan.
It’s possible that Medicare will approve coverage if eligible. Pain Management services in an outpatient setting generally have coverage under Part B.
Does Medicare Cover Euflexxa Injections
As long as you have Medicare Part B, you have Medicare coverage for Euflexxa injections. If you have knee pain in both knees, bilateral OsteoArthritis, you may be eligible to receive injections in both knees.
Talk to your doctor about treatment options, the best pain management plan is one you feel comfortable following.
Alternatives to Knee Replacement Surgery
Most arthritis pain is chronic with symptoms of pain lasting for many years. While osteoarthritis can affect all joints in the body, the most common area is the knee.
Common symptoms of osteoarthritis are the standard joint pain and stiffness. Look out for swelling, tenderness, decreasing range of motion, and redness at the pain site.
The activity can impact discomfort; so, seeking treatment is common for pain relief. Knee replacement alternatives that Medicare covers can give people more freedom.
Many knee pain suffers are familiar with knee braces and physical therapy for pain improvement
Knee bracing helps to provide stability and prevent further wear and tear to the affected joint. Simply wearing the brace will allow the joint to maintain function and the patient to remain active.
Physical Therapy is rehabilitative healthcare in which manual and therapeutic modalities improve the condition. With the knee, exercises improve strength in the surrounding muscles. This help improves stability and improves range of motion.
Cortisone injections go directly into the knee joint; cortisone can help decrease inflammation and fluid buildup, which in turn decrease a person’s pain.
Why Avoid Surgical Intervention
In some cases, surgery is medically necessary. You and your orthopedic surgeon can determine a plan; however, this is the last resort for many reasons.
With surgery comes downtime; this is a requirement to heal since the rehabilitation period can be painful.
As a whole, most physicians will advise you to exhaust all conservative treatment options prior to opting for an invasive surgical procedure, especially a large surgery like a knee replacement.
Does Medicare Cover Genicular Nerve Block
Genicular nerve blocks are investigational and not medically necessary. A diagnostic procedure; a professional injects local anesthetic around the genicular nerves (nerves that transmit pain affecting the knee).
If the patient receives temporary relief they’re a candidate for Genicular Nerve Ablation. This procedure is therapeutical with a local anesthetic and cortisone mixture that can provide longer-lasting relief.
Genicular Nerve Ablation is also investigational and not medically necessary. Patients that have successful results with a genicular nerve block become candidates for genicular nerve ablation.
The ablation cauterizes the genicular nerves which cause the pain; this provides anywhere from 6-12 months worth of pain relief before the nerve regenerates.
Is Coolief Covered By Medicare
Medicare should cover Coolief treatment. Although, we recommend confirming with your doctor and insurance provider.
This method of treatment doesn’t require any incision, no overnight hospital stay, and pain relief can last up to 12 months. Most patients report an increase in mobility.
In the Coolief clinical study, they found the treatment was longer-lasting and gave greater pain relief than the steroid injections. However, there are risks to all medical procedures; discussing your options with your doctor is very important.
Does Medicare Cover Knee Replacement
Medicare covers medically necessary procedures and supplies. Although, without Medigap coverage, you could incur deductibles and coinsurance expenses.
Determining costs before for your surgery can be difficult; so, many Americans look for knee replacement alternatives that Medicare covers. Predicting cost is difficult because costs vary between facilities, doctors, admission status’, and health plans.
Before resorting to surgery make sure you’re a candidate for the procedure. A candidate would have knee pain that affects activities of daily living.
Prior to surgery getting healthy is important; your doctor may ask you to quit smoking or eat healthier. Patients should heed their doctors’ advice.
Surgery is a costly procedure; however, shopping around town to see who offers you the best rate at a high-quality facility is something to consider. Beneficiaries can use the Hospital Compare tool to find a facility that is a “Center of Excellence”.
You can have your surgery wherever you like if you have standard Medicare; however, if you have a Medicare Advantage plan, you’ll likely need to stay in that network.
Medicare Supplement Plans for Those with Knee Pain
Medigap works with your Medicare; so, if Medicare approves the service, the Medigap plan approves. When preparing for a surgery or procedure always consider recovery time; you may need help with daily activities for a few days no matter which option you choose.
If Physical Therapy is necessary, plan that care beforehand to the provider is in your network and you understand costs. You shop around for the best prices on electronics, why not shop around with your healthcare?
Since Medicare only covers outpatient procedures at 80%, Medicare beneficiaries pay 20%. By obtaining a Medicare Supplement Plan you can have coverage for the coinsurance, copayments, and deductibles.
Call us or fill out our online form to compare rates. One of our licensed insurance agents can assist you today.