Medicare Changes Alert: What Phoenix Seniors Need to Know About Pain Treatment Coverage (Fall 2025 Update)

If you’re like most Medicare beneficiaries in Phoenix, you probably threw away that thick Medicare & You handbook that arrived last month. Who has time to decode 150 pages of government speak? But buried in that bureaucratic tome are changes that could directly affect whether you can afford the pain treatment you need.

The good news is that Dr. Asim Khan and Dr. Daniel Ryklin at Arizona Pain and Spine Institute have been helping Medicare patients navigate these waters for years. They’ve seen every prior authorization requirement, every coverage quirk, and every appeals process Medicare can throw at you. More importantly, they know how to work within the system to get you the treatment you need—and how to work around it when necessary.

With Open Enrollment starting October 15th, now is the time to understand what Medicare will and won’t cover for pain management, and how to make smart choices about your coverage for 2026.

What February’s Changes Really Mean for Your Pain Treatment

Back in February 2025, the Centers for Medicare and Medicaid Services (CMS) implemented sweeping changes to how they handle regenerative medicine and certain pain treatments. If you weren’t paying attention then—and let’s be honest, who was?—you might have been surprised when treatments that seemed like they should be covered suddenly weren’t.

The biggest change affects what Medicare calls “skin substitutes and cellular tissue products.” Now, that sounds like it has nothing to do with your aching back or arthritic knee, but here’s the catch: many regenerative treatments, including certain types of stem cell therapies and amniotic tissue products, fall into this category. Medicare essentially tightened the screws on what they’ll cover, limiting approval to very specific uses with mountains of documentation.

Dr. Khan explains it this way: “Medicare didn’t explicitly say ‘we won’t cover regenerative medicine for pain.’ They just made the requirements so stringent that most pain-related uses don’t qualify. It’s bureaucracy at its finest—or worst, depending on your perspective.”

What this means practically is that if you were hoping Medicare would cover that stem cell injection for your knee arthritis, you’re likely out of luck. The same goes for PRP (platelet-rich plasma) therapy for your chronic tendinitis. Medicare has essentially drawn a line in the sand: traditional treatments on one side, regenerative medicine on the other, and they’re only paying for the traditional side.

What Medicare Still Covers (The Good News)

Before you despair, let’s talk about what Medicare does cover, because it’s actually quite comprehensive for traditional pain management approaches. Understanding this can help you maximize your benefits and know when to use insurance versus when to consider other payment options.

Medicare Part B covers most medically necessary pain management procedures when properly documented. This includes epidural steroid injections for back pain, which can provide significant relief for herniated discs, spinal stenosis, and sciatica. If you’ve been suffering with radiating pain down your leg or chronic lower back pain, these injections are fully covered after you meet your deductible.

Facet joint injections and medial branch blocks are also covered. These are the bread and butter of treating arthritis-related back pain. If you’re one of the many Phoenix seniors dealing with facet joint arthritis—that grinding pain that gets worse when you arch your back—Medicare will cover both the diagnostic blocks and the therapeutic injections.

Here’s where it gets really interesting: radiofrequency ablation (RFA). This procedure, which can provide 6-24 months of relief by using heat to disable pain-transmitting nerves, is covered by Medicare when certain criteria are met. The key is having successful medial branch blocks first. Dr. Ryklin notes, “Medicare actually handles RFA coverage quite well. As long as we document that you got good relief from the diagnostic blocks, they’ll approve the RFA. It’s one area where the system works as it should.”

Trigger point injections for those painful muscle knots? Covered, within limits. Medicare allows a reasonable number per year when medically necessary. The same goes for joint injections—knees, shoulders, hips—using corticosteroids. Not the most advanced treatment, but they’re covered and can provide relief.

Perhaps most importantly for those with severe chronic pain, Medicare covers spinal cord stimulator trials and implantation. This is a significant benefit, as these devices can cost $30,000-50,000. “For patients with failed back surgery syndrome or complex regional pain syndrome, Medicare’s coverage of spinal cord stimulation can be life-changing,” says Dr. Khan. “We just need to document that conservative treatments have failed.”

What Medicare Won’t Cover (And Why It Matters)

Now for the frustrating part. Medicare has drawn some pretty firm lines about what they consider “experimental” or “not medically necessary,” regardless of how much these treatments might help you.

Platelet-rich plasma (PRP) therapy tops the list of non-covered treatments. Despite growing evidence of its effectiveness for arthritis, tendon injuries, and other painful conditions, Medicare considers it investigational. This is particularly frustrating for seniors who’ve heard success stories from friends or family members who’ve had PRP.

Stem cell therapy for orthopedic conditions is similarly excluded. Whether it’s amniotic stem cells, bone marrow aspirate, or adipose-derived cells, Medicare won’t pay for stem cell injections for your arthritis, back pain, or rotator cuff tear. The only stem cell treatments Medicare covers are for specific blood cancers and disorders—not much help for your aching joints.

Most regenerative medicine procedures fall into this non-covered category. This includes innovative treatments that could potentially help you avoid surgery or reduce your dependence on pain medications. The irony isn’t lost on Dr. Ryklin: “Medicare will pay $50,000 for a knee replacement but won’t pay $3,000 for PRP that might help you avoid that surgery.”

Certain newer procedures and technologies often face coverage delays of several years. By the time Medicare decides something is “proven,” there might be even better options available that face the same coverage delays.

The Medicare Advantage Trap (Or Opportunity?)

During Open Enrollment, you’ll be bombarded with ads for Medicare Advantage plans. Every celebrity from Joe Namath to William Shatner seems to be pushing one. But when it comes to pain management, these plans can be either a blessing or a curse.

Some Medicare Advantage plans offer additional benefits that Original Medicare doesn’t cover. For instance, certain plans might include limited coverage for acupuncture beyond what Medicare normally allows, or they might have partnerships with pain management clinics that offer discounted cash rates for non-covered services.

But here’s the catch that those celebrity spokespeople don’t mention: Medicare Advantage plans often require prior authorization for procedures that Original Medicare would approve automatically. That epidural injection that Original Medicare covers with just your doctor’s order? Your Advantage plan might require you to try physical therapy first, then oral medications, then document failure of both before approving the injection.

Dr. Khan has seen this scenario play out countless times: “A patient comes in with severe sciatica. Under Original Medicare with a supplement, I could give them an epidural injection that week. With some Advantage plans, we’re looking at weeks or months of prior authorization battles while the patient suffers.”

The network restrictions of Advantage plans can also be problematic. If Dr. Khan or Dr. Ryklin isn’t in your plan’s network, you might face significant out-of-pocket costs or have to switch to a provider you don’t know or trust.

The FastTrack Solution: When Time Matters More Than Coverage

This is where Arizona Pain and Spine Institute’s FastTrack program becomes invaluable for Medicare patients. Sometimes, the cost of waiting for Medicare approval—in terms of pain, lost function, and quality of life—exceeds the cost of just paying for treatment yourself.

Consider this scenario: You have severe knee pain from arthritis. Medicare will cover a steroid injection, but you’ve had three this year and they’re no longer helping much. Your doctor recommends PRP, which could provide longer-lasting relief, but Medicare won’t cover it. You could wait and suffer, hoping Medicare changes its policy (spoiler: they won’t anytime soon), or you could use FastTrack to get PRP now.

The FastTrack program offers transparent, upfront pricing. No surprise bills, no fighting with insurance. For many procedures, the cash price might be less than what you’d pay in deductibles and co-insurance battling through the Medicare system for covered treatments that don’t work as well.

“We see Medicare patients who’ve spent months getting approved for treatments that ultimately don’t help,” explains Dr. Ryklin. “With FastTrack, we can try innovative treatments immediately. If your Medicare plan won’t cover PRP but you can afford the $1,500-3,000 cost, why suffer for months with covered treatments that don’t work?”

Making Smart Choices During Open Enrollment

As October 15th approaches, here’s how to evaluate your Medicare options with pain management in mind.

If you’re generally healthy but have chronic pain conditions, Original Medicare with a good supplement (Medigap) plan might be your best bet. You’ll have the most flexibility in choosing providers and the least hassle with prior authorizations for covered treatments. Yes, you’ll pay more in monthly premiums, but you’ll have predictable costs and better access to care.

Look carefully at any Medicare Advantage plan’s provider network. Are your current pain management doctors in-network? What about the surgery center where procedures are performed? Being forced to change providers to save money rarely works out well for complex pain conditions.

Ask specifically about prior authorization requirements. Some Advantage plans advertise comprehensive coverage but require jumping through so many hoops that you might as well not have coverage. If you have chronic pain that requires regular treatments, these requirements can become a full-time job.

Consider your total medical picture. If you’re managing multiple chronic conditions and take expensive medications, an Advantage plan with good prescription coverage might save you money overall, even if pain management is more complicated. But if pain management is your primary medical concern, prioritize plans that make getting treatment easier.

Real Stories: How Phoenix Seniors Navigate the System

Let me tell you about Robert, a 72-year-old retired teacher from Mesa. He had Original Medicare with a Plan F supplement when he developed severe spinal stenosis. Medicare covered his epidural injections, and when those stopped working, they covered radiofrequency ablation. But when Dr. Khan suggested adding PRP to promote healing in his degenerating discs, Medicare said no.

“I did the math,” Robert told us. “My Plan F supplement costs me $280 a month, which is $3,360 a year. The PRP treatment was $3,000. I figured I’m already paying that much for insurance that won’t cover what I need, so I might as well pay for something that could actually help.”

Robert used FastTrack for the PRP while maintaining his Medicare coverage for other treatments. The combination approach—covered RFA for nerve pain, cash-pay PRP for disc healing—gave him the best of both worlds.

Then there’s Margaret, 68, from Scottsdale, who switched to a Medicare Advantage plan to save money. When she needed treatment for her chronic back pain, she discovered her plan required her to try six weeks of physical therapy first, even though she’d already done PT three times in the past two years. By the time she got approved for injections, she’d been in pain for three months and had developed compensatory hip pain from limping.

“I saved $150 a month on premiums but spent it all on extra doctor visits and over-the-counter pain medications while waiting for approval,” Margaret says. “Next year, I’m going back to Original Medicare.”

Planning Your Pain Management Budget

Here’s something your Medicare handbook won’t tell you: planning for a combination of covered and cash-pay treatments might be your smartest financial move.

Think about it this way. Your Medicare Part B deductible for 2025 is $240. After that, you pay 20% of covered services. If you have a supplement plan, it might cover that 20%. But you’re still paying monthly premiums for both Medicare and the supplement—often $400-500 per month combined for comprehensive coverage.

Now consider that many effective pain treatments aren’t covered anyway. Instead of paying high premiums for coverage that excludes the treatments you need, some seniors are choosing high-deductible plans and budgeting for cash-pay treatments.

Dr. Khan suggests this approach: “Use Medicare for what it covers well—diagnostic imaging, covered injections, medications, and surgery if needed. Set aside what you save on premiums for treatments Medicare won’t cover but that could keep you functional and pain-free.”

For example, if you typically need four medial branch blocks per year (covered by Medicare) and would benefit from PRP therapy (not covered), you might budget like this: Medicare covers the blocks after deductible and co-insurance. You pay cash for PRP once a year at $2,500. Your total out-of-pocket might be less than paying high premiums for coverage that still won’t include the PRP.

Taking Action: Your Pre-Enrollment Checklist

Before Open Enrollment begins on October 15th, here’s what you should do.

First, make a list of all pain treatments you’ve had in the past year and what’s planned for next year. Include everything—covered and non-covered. This gives you a realistic picture of your pain management needs.

Call Arizona Pain and Spine Institute at (480) 986-7246 and ask to speak with their insurance specialist. They can tell you exactly what your current plan has covered and what it’s denied. More importantly, they can tell you what treatments Dr. Khan or Dr. Ryklin recommend for your condition and which ones Medicare is likely to cover.

Review your current coverage and costs. Add up your premiums, deductibles, co-pays, and any cash payments for non-covered treatments. This is your baseline for comparison.

If you’re considering an Advantage plan, call and ask specific questions about pain management coverage. Don’t accept vague answers. Get specifics about prior authorization requirements, network providers, and coverage for the exact procedures you need.

Consider your priorities. Is predictable cost more important than comprehensive coverage? Is avoiding prior authorization hassles worth paying higher premiums? Would you rather have lower monthly costs and pay cash for innovative treatments, or higher monthly costs with more traditional coverage?

The Bottom Line: Knowledge is Power (and Less Pain)

Medicare’s coverage of pain management treatments isn’t getting more generous. If anything, the February 2025 changes signal a trend toward tighter restrictions on newer treatments. But that doesn’t mean you’re out of options.

Understanding what Medicare covers, what it doesn’t, and why can help you make informed decisions about your coverage and your care. Sometimes working within the system makes sense. Sometimes working around it with programs like FastTrack is smarter.

At Arizona Pain and Spine Institute, Dr. Khan and Dr. Ryklin have spent years learning how to maximize Medicare benefits while offering alternatives when the system falls short. They’re not just pain management physicians—they’re your advocates in navigating the complex intersection of pain treatment and insurance coverage.

As you face Open Enrollment decisions, remember that the cheapest plan isn’t always the most economical if it doesn’t cover the treatments you need. The most comprehensive plan isn’t worth it if you’re paying for coverage of treatments that don’t work for your condition.

Your pain doesn’t care about Medicare’s coverage determinations. But with the right knowledge and the right medical team, you can get the treatment you need, whether Medicare covers it or not.

Don’t let Medicare’s limitations limit your life. Call Arizona Pain and Spine Institute today to discuss your options—both covered and cash-pay. Because when it comes to living without pain, sometimes the best investment you can make is in treatments that actually work, regardless of what Medicare thinks.

Visit their website to learn more about covered treatments and FastTrack options. Knowledge truly is power, especially when it comes to managing your pain and your Medicare coverage.

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This article provides general information about Medicare coverage as of Fall 2025. Coverage policies can change. Always verify current coverage with Medicare and your specific plan. Consult with healthcare providers and insurance specialists for personalized advice.