Gout and Medicare

Gout and Medicare

How Does Medicare Cover Gout?

If you have gout, you know that flare-ups are unexpected and extremely painful. The good news is that treatment is available manage the pain and even reduce the frequency of attacks and potential for complications.

If you have Medicare, here’s what you should know about how Medicare covers diagnosing and treating acute and chronic gout.

Medicare and Gout Diagnosis

Gout is a form of arthritis with unique, unsubtle symptoms, which means it’s generally easy for your doctor to diagnose without a lot of additional medical tests. In some cases, the symptoms may mimic a bacterial infection in the joint, requiring additional testing to confirm the presence of gout.

In addition, there are several tests and procedures your doctor may recommend to determine the level of uric acid and creatinine in your blood, and to check for the presence of urate crystals in asymptomatic joints.

These tests and procedures may include:

  • Joint fluid aspiration to detect urate crystals.
  • Bloodwork to rule out infections and check uric acid levels.
  • Ultrasound to detect tophi if chronic tophaceous gout is suspected.
  • CT scans to look for crystals in joints, although these are rarely ordered.

What Medicare Covers

Part B covers all medically necessary doctor visits and outpatient tests to diagnose gout. You pay 20% of the allowable charges after your Part B deductible is met. If you have enrolled in a Medigap plan, then that coverage will cover some or all of that 20% depending on which plan you enroll.

If you have a Medicare Advantage plan, your cost-sharing may be different. You may pay a flat copayment amount for doctor visits and outpatient tests, and you may or may not have a deductible. Check your plan’s Summary of Benefits for specifics on what you should expect to pay.

Medicare and Gout Treatment

Gout treatment has three objectives—to manage the pain and symptoms of an acute attack, to prevent or reduce the frequency of attacks, and to prevent complications from gout.

Most gout treatment is in the form of medications, which may include:

  • Over-the-counter non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen and naproxen to treat pain.
  • Prescription pain medications such as Indocin or Celebrex.
  • Colchicine, which can be used for both pain relief during an acute attack, and as a daily treatment to prevent future attacks.
  • Corticosteroids to treat joint inflammation and pain. These can be taken as an oral medication in pill form or injected into the affected joints.
  • Prescription medications such as Aloprim and Uloric that block the production of uric acid.
  • Prescription drugs known as uricosurics (Probalan, Zurampic) that help your kidneys remove uric acid from the body.

During an acute attack, you may also wear a protective boot to take pressure off the affected joint to help relieve pain. Some people also use a cane to limit the pressure on painful joints when they walk.

What Medicare Covers

Original Medicare doesn’t generally cover any retail outpatient prescription drugs or over-the-counter medications you take at home, so most gout treatment isn’t covered under Part B. The only exception is steroid injections given in your doctor’s office. Part B pays 80% of allowable charges for a steroid injection.

However, if you have Part D coverage for your prescription drugs, then most, if not all, gout treatment prescriptions should be covered. Depending on the plan you choose, you may have a percentage-based cost-sharing structure or a flat copayment. Some plans have tiered cost-sharing structures, in which your out-of-pocket costs are lower for less expensive generic drugs and higher for specialty and brand-name medications.

Some Part D plans do help offset the cost of over-the-counter medications, but you should consult your specific plan for benefit details for over-the-counter drugs.

If your doctor prescribes a boot or other medical equipment, such as a cane, Part B may cover 80% of allowable charges. These devices are considered durable medical equipment, and if both your doctor and your equipment supplier participate with Medicare, you pay just 20% for medically necessary devices and equipment.

Other Medicare Coverage for Gout

Your doctor may suggest diet and lifestyle changes to help reduce your risk of complications from gout and prevent future attacks. This may include losing weight since overweight people produce more uric acid and their kidneys aren’t as effective at removing it.

If you are overweight with a BMI of 30 or more, Medicare covers weight loss counseling sessions by a qualified provider. You pay nothing for these sessions under Part B.

Certain medications, such as diuretics used to treat hypertension, may actually increase uric acid levels. If you are on multiple medications to treat different medical conditions, and you are enrolled in a Part D prescription drug plan, you may be eligible for medication therapy management services by a registered pharmacist.

During medication therapy management, your pharmacist will take an in-depth look at the medications you currently take and talk to you about how they are working, any side effects you’re experiencing, and how the medications together might actually worsen other conditions or cause additional side effects. He or she will also look for ways to help lower your medication costs.

After your consultation, the pharmacist works with your doctor to make sure the medications you take are actually improving your health. You’ll get a written report and an action plan to help you get the most benefit out of your prescription medications. You may be eligible for these services once a year at no cost to you. Check with your Part D plan for details, and if there are restrictions on the pharmacist you see for your medication therapy management services.

 

Danielle K Roberts and her team at Boomer Benefits assist Medicare beneficiaries with understanding their benefits and supplemental plan options. You can read more about them here.

Gout and You Banner

CHECK OUT OTHER RELATED POSTS:

Gout Research

Disability Allowance for Gout

Gout in Lumbar Spine

5 Comments

  • Michael M

    Reply Reply August 1, 2018

    I am 30 about 6ft and 270 lbs. I had my first gout flare up last year and it lasted a couple weeks before I learned what it was. My Dad and brother both have it and both have gone to the Dr. to get meds.

    I have heard some of the side effects and am worried about getting on medicine. However I have been suffering a bad ankle and foot attack for three weeks now with little relief. I have not eaten ANY meat, drank any Alochol, Eaten Sweets, or Anything Fried yet it keeps going on…

    I am at my whits end and am ready to go to the Dr. if it’s not better by next week. Are there any risks or consequences to me having an attack last a few weeks? I have lost ten lbs over the last few weeks with my change of diet but the pain is brutal.

    • Spiro Koulouris

      Reply Reply August 2, 2018

      IF you are 30 and have gout, the root cause is probably genetic like mine and bad dieting is what triggered it. Diet alone may not be enough to control your gout. I take allopurinol and there are no side effects so don’t worry about it too much. Best to visit your doctor and get a blood test done to see how high your uric acid levels are at and take it from there. You can talk to your doctor afterwards to see if you want to try dieting alone before embarking on medication. Don’t ignore it cause a gout attack risks harming your joints.

      Good luck!

  • Bill

    Reply Reply July 24, 2018

    I was diagnosed in my early 30s, a little over ten years ago. It got pretty bad until I lost a lot of weight, then subsided until I started to put weight back on in my late thirties. At that point I again got control of my diet and went on 100mg allopurinol. The allo was like magic — gout just disappeared suddenly.

    So fast forward a few years and until a few days ago, I’d only had a couple twinges and one short toe flare. But in the meanwhile I let myself go, getting fatter than ever and drinking large quantities of beer on a daily basis.

    Looks like that just caught up to me, because I’m in the middle of a brutal ankle attack.

    What’s frustrating is that just a few weeks ago I made a decision (not influenced by gout, but rather just by how uncomfortable it is to be fat and out of shape) to lay off the beer and lose weight, and I was succeeding so far. So just when I cut down the beer and start eating less I get hammered with my worst gout attack in at least 5 years.

    At this point, what I’m wondering is whether I should up the medication or stick with my fitness plan and try to ward off the gout with a healthier lifestyle. I also wonder whether my out of the blue attack may have been caused by suddenly changing my habits.

    • Spiro Koulouris

      Reply Reply July 25, 2018

      Hi Bill!

      Seek the advice of a qualified rheumatologist and if you want to try to stick with a fitness and diet plan make sure to monitor your uric acid levels frequently and based on the results make a decision on what do along with your doctor’s advice.

      Good luck!

    • Ari

      Reply Reply September 30, 2018

      Drinking beer, definitely increases your Uric Acid level. The day I experienced my first gout attack, I woke up with a sore toe. I went to the bar to watch a basketball game and drank beers. I could not walk out of there. I know alcohol is bad for gout. But if you’d like to drink make sure to drink wine. I am experiencing my second attack within five months and this time it’s on my right ankle. I am learning more and more about my body and uric acid. I know I do want to get back in shape. One thing that’s helped me is taking is NutriGout. I will keep researching on which medicine doesn’t have side effects.

Leave A Response

*

* Denotes Required Field