Are Cortisone Shots Covered by Medicare?
Demystify Medicare coverage for common medical injections, understanding eligibility criteria and financial implications.
Cortisone shots involve injecting corticosteroids to alleviate inflammation and pain. These injections are frequently used to manage conditions such as arthritis, tendonitis, and joint pain. For individuals enrolled in Medicare, these treatments are generally covered when a healthcare provider determines them to be medically necessary.
Original Medicare Coverage for Cortisone Shots
Original Medicare, Part A and Part B, covers cortisone shots. Most cortisone injections are covered under Medicare Part B for outpatient medical services. This includes administration in a doctor’s office, an outpatient clinic, or a hospital outpatient department. Coverage under Part B requires that the injection be deemed medically necessary by a healthcare provider for a diagnosed condition, such as joint inflammation or pain.
If a cortisone shot is administered as part of a covered inpatient hospital stay, Medicare Part A would provide coverage. Part A primarily covers hospital insurance, including services received during a formal inpatient admission. Most cortisone shots are administered in an outpatient setting, making Part B the more common source of coverage.
Costs Associated with Original Medicare
When cortisone shots are covered by Original Medicare, beneficiaries are responsible for certain out-of-pocket costs. Under Medicare Part B, an annual deductible must be met before Medicare begins to contribute to the costs. For 2025, this Part B deductible is $257. After satisfying this deductible, beneficiaries typically pay 20% of the Medicare-approved amount for the service, which includes the doctor’s service and the medication itself.
The remaining 80% of the Medicare-approved amount is paid by Medicare. Costs can vary depending on the setting where the injection is received; for example, an injection administered in a hospital outpatient department might incur additional facility fees compared to one given in a doctor’s office. If the cortisone shot is covered under Medicare Part A during an inpatient hospital stay, a different cost structure applies, including a deductible of $1,676 per benefit period for 2025.
Medicare Advantage and Medigap Plan Coverage
Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans are required to cover at least all the benefits provided by Original Medicare, including medically necessary cortisone shots. However, Medicare Advantage plans often have different cost-sharing requirements, such as copayments or deductibles, and may require beneficiaries to use in-network healthcare providers. It is advisable for individuals with a Medicare Advantage plan to consult their specific plan details to understand their out-of-pocket expenses and provider network rules.
Medigap, or Medicare Supplement Insurance, policies work in conjunction with Original Medicare to help cover some of the beneficiary’s out-of-pocket costs. These policies can assist with expenses like the Medicare Part B deductible and the 20% coinsurance. It is important to note that Medigap plans are designed to supplement Original Medicare and cannot be used with Medicare Advantage plans. A Medigap policy can significantly reduce the financial burden associated with cortisone shots by covering costs that Original Medicare does not.