Medicare Coverage for Arthritis (2026)

What Medicare covers for arthritis

• Rheumatologist visits: Under Part B at 80% after deductible.
• Biologics (Humira, Enbrel, Remicade, Rinvoq, etc.): Self-injectable biologics under Part D; office-administered (Remicade infusion) under Part B. The 2026 $2,000 Part D OOP cap is huge for biologic users.
• Joint injections: Cortisone, hyaluronic acid (e.g., Synvisc), platelet-rich plasma — most covered under Part B.
• Joint replacement surgery: Hip, knee, shoulder replacements covered under Part A (inpatient) or Part B (outpatient depending on facility).
• Physical therapy: Covered under Part B with no annual visit cap (medical necessity required).
• Durable medical equipment: Walkers, canes, braces covered under Part B.

Best plan structure for arthritis patients on biologics

For biologic users, the 2026 Part D $2,000 cap means even Humira ($90k+/yr retail) costs you $2,000. Choose your Part D plan carefully — some include all biologics on Tier 5, others use prior auth or step therapy that delays access.

Medigap Plan G + Part D if you want maximum specialist freedom (any rheumatologist takes Medicare). MA HMO plans can offer $0 premium but check the network has your rheumatologist + the formulary covers your specific biologic.