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Your Guide to Understand Does Medicare Cover Cortisone Injections?
Absolutely, Medicare does cover cortisone injections. It just doesn’t cover them all the time. There are some specific conditions you’ll need to meet. Want to know what those are? Then keep reading!
If you’re thinking about getting a cortisone injection to ease that stubborn pain or inflammation, you’re likely wondering if Medicare will pitch in for the cost. We get it, healthcare expenses can add up fast.
Below you’ll get an in-depth overview of Medicare coverage for cortisone injections. Here’s a quick glimpse of what you’ll find:
- Learn when Medicare helps with cortisone injections.
- Discover what Medicare Parts A and B do for these injections.
- Find out about other treatment options like physical therapy, acupuncture, massage, and yoga.
- Get a clear idea of possible costs involved.
Keep reading to make sense of Medicare and get the information you need.
Table of Contents
Does Medicare Cover Cortisone Injections?
The short answer is yes. Medicare will cover the cost of cortisone injections. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your cortisone injections. Below we look at what these are so you know what to expect.
Original Medicare Coverage for Cortisone Shots
Original Medicare (Medicare Part A and Part B) provides coverage for cortisone injections. But Original Medicare only provides coverage for your cortisone injections if it is considered medically necessary.
Your healthcare provider must first order the treatment for Original Medicare to provide coverage.
Medicare Part A Coverage for Cortisone Injections
Coverage for cortisone injections is provided by Medicare Part A if it is administered in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.
Medicare Part B Coverage
Coverage for cortisone injections is often provided by Medicare Part B because it usually takes place in an outpatient setting. However, Medicare Part B will only provide coverage for cortisone injections if a licensed medical professional will administer it.
The healthcare provider who prescribed the drug, and the pharmacy where you buy, it must accept Medicare assignment. It must also be given as part of your healthcare provider’s service.
Once approved, Medicare Part B covers 80 percent of the costs of your cortisone injections. You will pay for the remaining 20 percent.
Medicare Part B also provides coverage for other types of injections targeting osteoarthritis besides corticosteroids (which include cortisone). These include hyaluronic acid injections and placental tissue matrix injections.
For Medicare Part B to provide coverage for these injections, you will also need to undergo an x-ray to show that you have osteoarthritis. Once approved by Medicare Part B, they will provide coverage for one injection every six months.
Part C Coverage for Cortisone Injections
Medicare Advantage plans (Medicare Part C) also provide coverage for cortisone injections. These plans have to cover everything Original Medicare covers but offer some additional benefits as well. The plans you have, however, will determine exactly what is covered and what your out-of-pocket expenses will be.
Cortisone Shots and Medicare Part D (Prescription Drug Coverage)
Generally speaking, over-the-counter cortisone items aren’t covered by Part D. But there’s a silver lining—some exceptions do exist.
For instance, if you receive a cortisone injection at a doctor’s office or an outpatient hospital setting, or if your doctor prescribes you cortisone cream for a particular medical problem, you could be in luck.
Unsure about your coverage? Your best bet is to check with your plan administrator for the specifics.
Tips for Ensuring Cortisone Injection Coverage Under Medicare
First, chat with your healthcare provider—they’ll help you figure out if the injections are a good fit for you and if Medicare is likely to cover it.
Next, give your specific Medicare plan a quick check because coverage details can vary.
And don’t forget about supplemental Medicare policies like Medigap. These plans can cover extra costs like copays and deductibles.
How Much Do Cortisone Injections Cost?
Cortisone injections can cost anywhere from $25 to over $1,000. Most commonly though you’ll find the cost in the $100 to $300 range.
Factors affecting this cost include the provider, where the injection is taking place, and the condition it is treating.
Potential Out-of-Pocket Costs
Wondering about the potential out-of-pocket costs for cortisone injections under Medicare? It can vary based on your specific Medicare plan, the type of injection, and where you get it.
First off, there’s an annual deductible you’ll need to meet. Until you hit that deductible, you’ll pay the full cost for services, including cortisone injections.
Once the deductible is hit, you’re on the hook for 20% of the covered service costs.
But wait, there’s more. Some Medicare plans add a copayment to cortisone injections, a fixed fee you pay each time you get one.
As you can see, the exact out-of-pocket expenses can be quite different depending on your unique Medicare plan and situation.
For the details, check out your plan’s Summary of Benefits and Coverage (SBC).
What Are Cortisone Injections?
Cortisone injections are a type of steroid medication that gets directly injected into a joint or a specific area of your body. They’re pretty handy for taming pain, swelling, and inflammation.
These injections come to the rescue when you’re dealing with conditions like arthritis, tendinitis, bursitis, epicondylitis (tennis or golfer’s elbow), plantar fasciitis, shin splints, sciatica, carpal tunnel syndrome, a painful shoulder, or even the discomfort of a frozen shoulder.
Their secret weapon? Cortisone is a champ at squashing those trouble-making chemicals that stir up inflammation. So, if you’re curious about how cortisone injections might help you with any of these issues, you’re in the right place.
Alternative Treatments and Their Medicare Coverage
Exploring Different Treatments and Medicare Coverage
Cortisone shots help with pain and swelling, but they’re not the only option. Some people prefer more natural or long-lasting solutions. There are other treatments that Medicare might help pay for.
Some treatments similar to cortisone shots are:
- Physical Therapy: It helps improve movement, reduces pain, and strengthens muscles. If a doctor says you need it, Medicare Part B can help pay for it.
- Acupuncture: This involves putting thin needles into your skin at certain spots to ease pain and improve how your body works. Medicare Part B doesn’t usually pay for acupuncture, but some Medicare Advantage plans might.
- Massage Therapy: It can help relax your muscles and relieve pain. If a doctor recommends it, Medicare Part B can cover it.
- Yoga: Yoga is about moving your body and feeling better, but it’s not a medical treatment, so regular Medicare doesn’t pay for it. However, some Medicare Advantage plans might.
How Medicare Deals With These Treatments
How much Medicare helps pay depends on your specific plan. Part A covers hospital stuff, Part B covers doctor visits, and Part D helps with prescription drugs.
In a nutshell, Part B can cover physical therapy, acupuncture, and massage therapy if a doctor says you need them. But there are rules. For example, they won’t pay for acupuncture just for headaches.
Keep in mind, Medicare doesn’t pay for yoga or other treatments that aren’t considered medical. But if you have a Medicare Advantage plan, it might help with these treatments.
Medicare’s Approach to These Alternative Treatments
Coverage for these alternative treatments within Medicare depends on your specific plan. Medicare Part A handles inpatient care, while Part B covers outpatient care. Additionally, Part D covers prescription drugs.
In a general sense, Medicare Part B covers physical therapy, acupuncture, and massage therapy when prescribed by a doctor, but some restrictions apply. For instance, acupuncture for headaches or pain relief isn’t covered.
It’s important to note that Medicare doesn’t cover yoga or other alternatives considered non-medical services. However, you might find coverage for such treatments through certain Medicare Advantage plans.
Summary of Medicare Coverage for Cortisone Shots
We’ve covered a lot about Medicare and cortisone injections. The bottom line, Medicare can help cover the cost of these injections when your health needs them. We explained how the different parts of Medicare, like Part A, Part B, and Part D, come into play.
We also looked at some other options like physical therapy, acupuncture, massage, and yoga that could make you feel better. But remember, understanding your specific Medicare plan is essential for managing costs and getting the care that suits you.
Now, what’s your next move? We suggest having a chat with your doctor and taking a peek at your Medicare plan details to make wise choices.
Frequently Asked Questions
Will Medicare Cover Cortisone Shots in Knees?
Medicare Part B pays for knee cortisone shots if your doctor says they’re needed for your knee pain. These shots help with arthritis pain by reducing swelling and usually work for 2-3 months.
Can You Get a Cortisone Shot From Your Primary Care Doctor?
Your primary care doctor can give you a cortisone shot if they’re allowed to do injections. They’ll check if it’s the right treatment and then give you the shot in the affected area.
How Are Steroid Shots and Cortisone Shots Different?
Steroid and cortisone shots are the same. They’re both injections with corticosteroids, which lessen swelling. Our body makes these, but we can also create them in a lab.
How Long Do Cortisone Shots Last in a Joint?
Cortisone shot duration differs per person and situation. It can offer relief for weeks to months. For instance, a knee injury shot may last around 3 months, while one for hand arthritis could go up to 6 months. Sometimes, one shot won’t cut it, and you might need more.
Is a Cortisone Injection Worth It?
The cost of cortisone shots with Medicare varies by plan. Usually, Medicare Part B covers it when a doctor prescribes it to help your health.
How Many Cortisone Shots Can You Safely Get?
Usually, you can’t get too many cortisone shots in a year – around 3 or 4 is the norm. But in some cases, like chronic conditions, your doctor might OK more. Also, if it’s for surgery prep, they might make an exception.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.