Waking up with a knee that feels like it’s filled with ground glass is a special kind of misery. If you’re on Medicare, your first thought—after "ouch"—is probably whether the government is going to help you pay for a fix. Specifically, those cortisone shots that everyone at the community center swears by.
The short answer? Yes, Medicare does cover cortisone shots, but it isn't always a "walk-in and get it for free" situation.
Medicare is kinda picky. They don’t just pay for every needle that enters a joint because you asked nicely. There are rules about medical necessity, which "part" of Medicare pays the bill, and some brand-new 2026 regulations that might trip you up if you live in specific states.
The Breakdown: How Medicare Parts Handle the Needle
Honestly, the most confusing part of Medicare is the alphabet soup. For cortisone, you’re usually looking at Medicare Part B.
Since these injections are typically done in a doctor’s office or an outpatient clinic, they fall under medical insurance. You don't go to the pharmacy, buy a vial of cortisone, and bring it to your doctor. The doctor provides the medication and the labor.
If you’re stuck in a hospital bed and they give you a shot, Part A takes over the bill.
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What’s it going to cost you?
In 2026, the Part B deductible is $267. If you haven't hit that limit yet for the year, you’re paying the full Medicare-approved price for the shot. Once that’s cleared, you usually owe 20% of the cost.
Data from the last year or so shows that if you go to an ambulatory surgical center, you might pay around $20 out of pocket. If you go to a hospital outpatient department, that same shot might cost you closer to $70. It’s the same medicine, just a different building. Wild, right?
Why Medicare Might Say "No"
Medicare won't pay for a cortisone shot if they think it's "cosmetic" or unnecessary. For example, if you want a steroid shot to clear up a stubborn pimple before a wedding—that’s a hard no.
They also generally want to see that you’ve tried the "boring" stuff first. This is called conservative therapy. Doctors like Dr. Oracle and researchers in Frontiers in Pharmacology note that Medicare often expects you to have tried:
- Physical therapy (PT)
- Over-the-counter anti-inflammatories (like Ibuprofen)
- Weight loss or activity modification
If you’ve done those for about six weeks and your hip still feels like it’s on fire, Medicare is much more likely to green-light the injection.
🔗 Read more: That Weird Feeling in Knee No Pain: What Your Body Is Actually Trying to Tell You
The 2026 "WISeR" Reality Check
Here is something most people are going to miss this year. Starting January 1, 2026, Medicare launched a pilot program called the Wasteful and Inappropriate Service Reduction (WISeR) Model.
If you live in Arizona, New Jersey, Ohio, Oklahoma, Texas, or Washington, your doctor might have to get "prior authorization" for certain injections. Specifically, epidural steroid injections (the ones for back pain) are under the microscope.
Basically, your doctor has to send the paperwork before the shot to prove you actually need it. If they don't, Medicare might refuse to pay entirely, leaving you with the whole bill. If you're in one of those six states, ask your doctor, "Hey, do we need prior auth for this under the 2026 pilot program?"
How Often Can You Get Jabbed?
You can’t just get these every week. Not only is it bad for your bones (it can actually degrade the cartilage if you overdo it), but Medicare has a "cooldown" period.
Usually, Medicare will cover one shot per joint every three to four months. If you try to get a second shot in the same knee only six weeks after the first one, Medicare will likely flag it as "not medically necessary" and deny the claim. They want to see that the shot actually provided relief for a decent chunk of time before they pay for a repeat performance.
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Medicare Advantage: The Private Twist
If you have a Medicare Advantage (Part C) plan from a company like UnitedHealthcare or Aetna, the rules are slightly different.
By law, they have to cover what Original Medicare covers. However, they can be a lot more aggressive with "step therapy." They might insist you do exactly 12 sessions of physical therapy before they’ll pay for a cortisone shot. They also might have different co-pays. One plan might charge you a flat $40, while another sticks to the 20% rule.
Always check your plan's Evidence of Coverage (EOC) document. It’s that massive book they mail you every year that most people use as a coaster. Search for "Podiatry" or "Specialist Services" to find the injection rates.
Real Talk on the Process
- The Diagnosis: Your doctor needs to document "Osteoarthritis" or "Bursitis" or something specific in your chart. "My leg hurts" isn't enough for a claim.
- The Location: Try to get it done in your doctor’s office. Hospital settings trigger "facility fees," which are basically a cover charge just for walking through the door.
- The Supplemental: If you have a Medigap plan (like Plan G), that 20% co-insurance you usually owe? The Medigap plan will likely pick that up, making the shot essentially $0 out of pocket once your deductible is met.
What Most People Get Wrong
A big misconception is that the "drug" is the expensive part. Cortisone is actually pretty cheap. The money goes toward the doctor's time, the ultrasound machine they might use to guide the needle (which is also covered if necessary!), and the "surgical suite" fee.
Also, don't confuse cortisone with hyaluronic acid (the "gel" or "rooster" shots). Medicare is much stingier with the gel shots and often requires even more proof that cortisone failed before they'll pay for the expensive stuff.
Actionable Next Steps
- Call your doctor's billing office and ask for the "CPT code" for the injection they plan to give you.
- Check your deductible status on the MyMedicare.gov portal to see if you’ll be paying the full price or just the 20%.
- Ask for a copy of your records showing you've tried physical therapy or other meds, just in case the claim gets denied and you need to appeal.
- If you live in the 6 pilot states (AZ, NJ, OH, OK, TX, WA), ensure your doctor has submitted the prior authorization paperwork at least 7 days before your appointment.