health insurance benifits and back pain

Back Pain and Your Medicare Benefits

Back pain is a common complaint that many Americans have.  Back pain is a leading ailment that causes people to visit a doctor every year.  80 percent of Americans experience low back pain at least once in their lifetime.  Back pain can range from a dull ache to a sudden sharp pain that limits mobility.  Back pain can gradually become more of a problem over time or it can come on quickly if you suffer an injury.

Does Medicare Provide Benefits to Help with Back Pain?

Medicare Part B does cover chiropractic manipulations of the spine to correct subluxations of the spine (spinal bones out of position). Chiropractic adjustments are an effective method of treating back pain, joint pain and headaches.  Often chiropractic adjustments can help to alleviate pain and muscle stiffness and tightness which improves flexibility and helps the tissue heal.

Seniors with Medicare can have chiropractic adjustments covered if they have neuromuscloskeletal conditions, have subluxations of the spine or need manual manipulations to improve a condition.

Medicare Part D and Back Pain

If you have Medicare Part D your medications prescribed by a doctor to treat pain or other symptoms of back pain may be covered.  I will depend on which Part D plan you currently have, so you will need to check which prescriptions are covered and are not covered.

If the medications you need are not covered under your current plan, you can switch to a plan which does cover it during the annual election period, open enrollment from October 15 through December 7 annually.

Epidural Steroid Shots and Medicare

One of the most popular means to alleviate back pain and more people are turning to- epidural steroid shots to treat their persistent pain.  Recent studies document a 629 percent increase in Medicare expenditures for epidural steroid injections.  It is proposed that this year, 2014 Medicare may be scaling back on those treatments, by limiting the number of injections a patient can receive during the year.  The reason they state is-over time the injections may weaken your bones and studies show that after two injections the patient sees no added benefits.  The medical community is afraid these patients, if denied their benefits and the injections, they may turn to addictive painkillers such as opiates and pain narcotics, causing an additional concern.  Medicare’s response to this concern is-if this proposal does go into effect the patients can always appeal.

TENS and Medicare

TENS stands for Transculaneous Electrical Nerve Stimulation which is a treatment for chronic back pain.  This method uses an electrical current which is applied directly to the skin then the nerves are stimulated to provide pain relief. The device is small and portable, using batteries to run the electrical pulse generator which produces an electrical current. Wires from the electrical pulse generator connect to electrode pads which are applied directly to the skin. The frequency of the electrical current is determined by pain level and doctor recommendation. The devices, sold as units, can be either durable or disposable.

TENS units are easy to use and can be self-administered in the home or at a doctor’s office. It is often used for chronic ailments like osteoarthritis and back pain, but is also administered as a treatment for acute pain by patients who have recently undergone surgery. In such cases, TENS treatment is usually only necessary for 30 days or less.

Does Medicare cover TENS??

Medicare covers TENS and considers the units as durable medical equipment (DME). A patient who uses TENS devices in the hospital may be covered under Medicare Part A for inpatient care. For outpatient care, TENS is considered supplies and is covered under Medicare Part B as DME.

You may qualify for Medicare if you are suffering from chronic lower back pain and your daily activities have been affected for more than three months. To be diagnosed with chronic back pain no other disease may be the underlying cause of pain. In order to receive TENS coverage, a person must also be enrolled in a clinical study that meets certain requirements such as a proven reduction in pain. For acute pain after surgical operations, patients are also qualified for TENS for a limited time until, if pain persists, they are treated for chronic pain. Under Part B of Medicare, all durable medical equipment (DME) is covered by Medicare – up to 80 percent of the cost. A patient is required to cover the remaining 20 percent.   Medicare goes through changes often before your doctor and you decide on any treatment for chronic back pain make sure your Medicare Plan will cover it.

Barbara Lucore

I have been a nurse for 15+ years and as a nurse I understand how to prevent back strain and pain. The correct ways to lift objects, the causes of back pain, treatments available, the exercises to reduce or prevent back pain and the proper ways to move without strain or injury to your back.