Does Medicare Cover Cortisone Injections?

Around a quarter of all Americans aged 65 and older have arthritis, according to the Centers for Disease Control and Prevention (CDC). 

Doctors use cortisone injections, a drug used to treat inflammation, as an effective treatment option for arthritic conditions. Cortisone can help people with rheumatoid arthritis, reactive arthritis, and osteoarthritis. These injections can also relieve other painful conditions like back pain, tendinitis, and gout. 

If your doctor recommends cortisone shots, it’s useful to understand how Medicare covers cortisone injections.

What Parts of Medicare Cover Cortisone Injections?

Original Medicare (Medicare Parts A and B) and Medicare Advantage plans (Medicare Part C) provide limited coverage for cortisone injections.

If you have Original Medicare, you can manage some of your out-of-pocket Medicare costs for covered cortisone injections with a Medicare Supplement (Medigap) plan.

Medicare Part A and Part B Coverage

Cortisone injections are generally intra-articular, meaning they are delivered directly into a joint to reduce inflammation and pain. They are administered by a medical professional.

Medicare Part B covers the cost of outpatient services, including injectable and infused drugs such as cortisone injections that are given by a licensed medical provider. If a doctor confirms that cortisone shots are medically necessary, Part B covers 80% of the cost. 

If a doctor prescribes cortisone during a hospital stay, such as after a hip or knee replacement, Medicare Part A covers the injections.

If you’re a woman with osteoporosis, your doctor may not recommend cortisone, but it’s worth knowing that Medicare Part B covers some injectable osteoporosis drugs. You may receive this coverage if:

• You qualify for the Medicare home health benefit
• You have a bone fracture related to post-menopausal osteoporosis

You can’t give yourself the injection and have no family or caregivers to provide this service.

Medicare Advantage plans must offer at least the same level of coverage as Original Medicare, meaning these plans also cover cortisone shots and osteoporosis drugs. 

Medicare Part D Coverage

Medicare Part D covers prescription drugs. If you need a prescription for cortisone tablets, your Part D plan may cover them. 

You can receive this coverage as a standalone Part D plan with Original Medicare or as part of a Medicare Advantage plan that includes prescription drug coverage. A licensed insurance agent can help you compare Medicare Advantage plans where you live and find a plan that covers prescription drugs as well as Part B-covered cortisone injections.

Medicare Supplement (Medigap) Coverage

Medigap plans help fill the gaps in your Original Medicare coverage, including some of the out-of-pocket Medicare costs for cortisone injections. A Medigap plan can reduce the cost of your appointment for cortisone injections by eliminating expenses for doctor’s visits like deductibles and copays.

You must have Original Medicare to buy a Medigap plan. Additionally, Medicare Advantage plans and Medicare Supplement plans are very different, and you can’t have each type of plan at the same time.

You can compare Medigap plans online or speak with a licensed insurance agent who can help you compare the plans that are available where you live.

How Much Does a Cortisone Injection Cost?

How much are cortisone shots? The Medicare cost of a single cortisone shot can range from $25 to $300 or even more. Several factors influence the price of the injection, including:

• Your city and state
• Your medical provider
• The injection site

Most people require cortisone injections regularly, which represents a substantial financial commitment. However, with Medicare, you only need to pay 20% out-of-pocket, and you could reduce this further with a Medigap plan.

How Often Will Medicare Pay for Cortisone Injections?

Although cortisone injections are incredibly beneficial, and the effects may last for several months, repeated injections can lead to further loss of cartilage. Doctors typically recommend a maximum of three injections annually.

Your Medicare coverage resets every calendar year. That means in most cases, Medicare covers three shots per affected joint between January 1 and December 31. Once a new year begins, your coverage is renewed.

Does Medicare Cover PRP Knee Injections?

Platelet-rich plasma (PRP) injections are another treatment option for post-surgery pain and chronic conditions like osteoporosis. 

In most cases, Medicare doesn’t cover PRP knee injections or other popular PRP shots, including injections in the shoulders, feet, and ankles. 

However, you may receive coverage if:

• You have chronic non-healing diabetic, pressure, or venous wounds
• You’re in a qualifying clinical research study

Does Private Insurance Cover Cortisone Injections?

Private insurance companies may offer more generous coverage for cortisone shots than Medicare with many policies covering medically necessary injections in hospitals and clinics. Insured patients may have out-of-pocket expenses as low as $10.

Medicare May Help With Pain-Relieving Injections

If a doctor suggests that cortisone injections could improve your wellbeing by relieving pain and inflammation, Medicare may cover some of the cost. 

Medicare Part B could cover 80% of the cost of cortisone injections, leaving you with a small proportion of out-of-pocket expenses to meet.