There’s no getting around it — as you age, your joints wear down. Many senior citizens experience joint pain, particularly in their hips. There are many causes and kinds of hip pain, from relatively minor sprains and strains all the way to degenerative conditions like osteoarthritis. If you’re experiencing hip pain, it’s a good idea to head to the doctor and find out what measures you can take to keep your hips happy and to put you back on your feet.

But the very idea of going to the doctor can produce anxiety. People may be afraid of needles, or nervous about hearing an unpleasant diagnosis. People over age 65 may avoid the doctor for another reason, as well; they’re afraid their issue won’t be covered by Medicare.

Medical Necessity

Medicare covers treatment based on whether it is “medically necessary.” That criterion can be complicated; it depends on federal and state regulations and on your doctor’s diagnosis. It’s always important to check your policy coverage to determine what kinds of procedures are – and are not – considered medically necessary. You can also check Medicare’s website or call them for more information.

A diagnostic procedure to determine the cause of your hip pain is usually medically necessary, so don’t avoid the doctor when you’re hurting!

Hip Pain Causes

Here are a few common hip pain diagnoses that may require treatment:


Hip bursitis is an inflammation of the bursae, small sacs filled with fluid that rest between the bone and soft tissue of a joint. Two bursae in the hip are most likely to become inflamed — the bursa that covers the bony point of the hip (the greater trochanter) and the one that cushions the inside of the hip near the iliopsoas muscle. Pain from the first will present as tenderness at the points of the hips; pain from the second will feel like groin pain.

Bursitis can be treated by several non-surgical interventions that are medically necessary according to Medicare. Potential treatments include drug interventions with Non-Steroidal Anti-Inflammatory drugs (NSAIDs) like ibuprofen, physical therapy, assistive devices like canes, and steroid injections.


Arthritis is an inflammation of the joints. Osteoarthritis is the most common kind of arthritis. It is a condition in which cartilage — the soft, malleable tissue that cushions the ends of bones in joints — begins to break down, causing pain, swelling, and sometimes even joint deformity. One study estimates that 7% of women over the age of 65 have radiographic hip osteoarthritis.

Osteoarthritis can sometimes be so severe that it causes trouble walking. The condition is degenerative and incurable, so treatment to manage the pain it causes is usually medically necessary. Treatments can range from physical therapy and lifestyle changes like losing weight to more extreme interventions, like hip replacement surgery.


Hip pain may not be caused by a problem with the hip at all! For instance, sciatica — a condition in which the sciatic nerve, a large nerve fiber that runs from your back all the way down your leg, is impinged — can cause pain in many places, including your hip. Treatment for sciatica can include medications and physical therapy. Check with your Medicare plan to determine whether treatment for sciatica is medically necessary.

Treatment Limits

Always check your policy to see if there are restrictions on your treatments for hip pain. For instance, your physical therapy visits could be limited, or your drugs might be covered only to a certain extent. Also, make sure to check with your doctor to find out which diagnostic codes — numbers associated with types of diagnosis and treatment — he or she has entered for services. Medicare allots coverage based on these codes, so it’s important that your doctor gets them right.

Medicare Part C and Medigap

Medicare Part C, also called Medicare Advantage, is Medicare administered by private companies. Part C covers all services provided by Medicare Parts A and B, and also offers additional services based on your provider and location. HealthMarkets Insurance Agency can discuss your Part C options with you and find a plan that fits your needs..

Medicare Supplement Insurance plans, also called Medigap plans, are designed to fill the “gaps” in other Medicare coverage. Call HealthMarkets to find out what kinds of Medigap plans may be available to you.

HealthMarkets is here to help. Give us a call anytime, day or night, and one of our 3,000 licensed agents will go to work getting you the coverage you need.

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