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Elderly lady grabbing her knee in pain

Are Knee Gel Injections Covered by Insurance?

As you age, developing osteoarthritis is common, resulting in painful and stiff joints. Osteoarthritis commonly affects the knees because it is a weight-bearing joint and because of the knee’s complex structure.

If you are suffering from osteoarthritis, your doctor may have recommended knee gel injections as a potential solution. This blog post will explore how knee gel injections work, whether Original Medicare covers this treatment, and the potential costs involved. 

How Do Knee Gel Injections Work? 

Knee Gel Injections Covered by Insurance - Medicare part B cover list and metal pen.

Knee gel injections work by adding a gel-like substance called hyaluronic acid to your knee joint. This substance is naturally found in the joint’s fluid and helps it move smoothly. However, osteoarthritis causes your joints to not produce enough hyaluronic acid, causing more pain and stiffness.

During the injection, a healthcare provider uses a small needle to put hyaluronic acid gel directly into your knee joint. Once inside, it acts as a cushion, reducing friction between the joint’s surfaces. You will find that you can move more easily and function more smoothly. 

While knee gel injections have proven beneficial for many patients, providing reduced pain and improved mobility, it’s vital to understand that this treatment primarily manages the symptoms and does not cure osteoarthritis. Typically, patients experience relief from knee pain for several months following the injection. 

Despite their effectiveness, some patients may encounter mild side effects, such as temporary pain or swelling at the injection site. On rare occasions, more serious complications can occur. Thus, it’s essential to discuss any potential concerns with your healthcare provider.

Although these injections do not eradicate osteoarthritis, they can significantly alleviate the symptoms, improving the quality of life for those suffering from knee pain.

Does Original Medicare Cover Knee Gel Injections?

Medicare Part A covers knee gel injections if administered during an inpatient hospital stay. Since the injections are primarily performed on an outpatient basis, they are covered by Medicare Part B. 

Medicare provides coverage for knee gel injections every six months, contingent upon medical necessity. To be eligible for this coverage, your treatment must be administered by a doctor who accepts Medicare assignments. The determination of medical necessity for these injections requires conclusive diagnostics, which could include an x-ray or other methods. Following this, your doctor needs to affirm that:

  • The injections are only for your knees and are FDA-approved
  • You have a diagnosis of osteoarthritis, and another condition does not cause your pain 
  • Over-the-counter treatments or alternative treatments are not enough to manage your pain.

Medicare Part B will cover 80% of the approved cost of your injections after the Part B deductible is met. You are responsible for your annual deductible ($226 in 2023) and the remaining 20%. 

Medigap and Medicare Advantage Coverage

A Medicare Supplement or Medigap plan might cover a portion or even all of the 20% you would typically have to pay out of your own pocket for knee injections.

Medicare Advantage plans are required to have at least the same coverage as Original Medicare, so you can expect that knee injections would be covered under Medicare Advantage as well. Some Medicare Advantage plans may have additional benefits or restrictions, such as requiring that you go to a doctor from within that plan’s network, which could impact you. 

How Much Do Knee Injections Cost?

Doctor giving patient injection in clinic, closeup. Knee problem treatment

The cost of knee gel injections varies depending on geographic location, healthcare provider, and specific treatment protocol. Generally, you can expect to pay between $500 and $1,300 per injection without coverage. 

Before undergoing knee gel injections, diagnostic testing is often necessary to assess the severity of your knee condition and determine the most appropriate treatment approach. Standard diagnostic tests include X-rays and MRI scans. Be sure to also budget for these diagnostic tests and any doctor visits. 

Are There any Alternatives to Knee Gel Injections?

Knee gel injections can effectively treat knee osteoarthritis and are a less invasive alternative to knee replacement surgery. However, you do have other options that you can use in conjunction with or instead of your knee gel injections.

Alternative treatments may include: 

  • Physical therapy
  • Using assistive devices like canes or walkers 
  • Nutritional changes to remove inflammatory foods from your diet
  • Weightloss if obesity is a factor
  • Modifying daily activities to reduce stress on your joints
  • Low-impact exercises, such as water aerobics or gentle chair yoga 

For most people with osteoarthritis, you will eventually require to replace your knee. However, knee gel injections can provide temporary relief and delay the need for knee replacement surgery.

Navigating your Medicare Coverage with The Medicare Family

Working with The Medicare Family can empower you to make smart choices about your Medicare coverage. As a family-owned company with over 40 years of experience, we have the knowledge and expertise to guide you through the complexities of Medicare. 

Let us be your trusted partner in navigating the Medicare landscape and securing the coverage that suits your unique needs. Schedule your free call with The Medicare Family today so you can clearly understand when and how to enroll in Medicare without facing any penalties. We can help you receive the best prices for Medicare Supplements and Medicare Advantage plans available in your area. 

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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