BCBS Coverage for HA Injections: Important Update
Coverage for hyaluronic acid injections varies significantly by BCBS plan and state. Most notably, BCBS Illinois is discontinuing coverage effective January 1, 2026.
Quick Facts
| Coverage Aspect | Details |
|---|---|
| Currently Covered? | Varies by state/plan |
| BCBS Illinois | Ending coverage Jan 2026 |
| Prior Authorization | Usually required |
| FEP Members | May retain coverage |
Critical Alert: BCBS Illinois
BCBS Illinois Coverage Ending
Blue Cross Blue Shield of Illinois will discontinue benefit coverage for viscosupplementation (HA injections) effective January 1, 2026. Federal Employee Program and government programs are excluded from this change.
Who Is Affected
| Group | Status |
|---|---|
| BCBS Illinois commercial members | Coverage ending Jan 2026 |
| Employer-sponsored BCBS IL plans | Coverage ending Jan 2026 |
| FEP (Federal Employee Program) | Coverage may continue |
| Government program participants | Coverage may continue |
| Other BCBS state plans | Check your specific plan |
Coverage by BCBS Plan Type
BCBS operates as independent companies in each state. Coverage varies:
Plans That May Cover HA
- Some state BCBS plans still cover viscosupplementation
- Federal Employee Program (FEP)
- Some employer-sponsored plans with broader benefits
- Plans that haven’t adopted restrictive policies
Plans That May Not Cover HA
- BCBS Illinois (effective Jan 2026)
- Plans following “experimental/investigational” designation
- Plans with strict medical policy exclusions
- High-deductible plans with limited benefits
You must check your specific plan to know your coverage status.
If You Currently Have Coverage
Before Coverage Ends
- Complete any planned injection series before December 31, 2025
- Ask about “maintenance patient” status which may extend coverage
- Document your treatment history and outcomes
- Explore Medicare eligibility if you’re 65+
- Consider switching plans during open enrollment
Appeal Rights
Even after coverage ends, you may appeal:
- Request specific clinical rationale for policy change
- Submit peer-reviewed evidence supporting HA efficacy
- Request independent medical review
- Contact Illinois Department of Insurance
Alternatives for BCBS Members
If You Lose HA Coverage
| Option | Details |
|---|---|
| Medicare | If 65+, stable coverage for HA |
| Self-pay | $300-$1,500 per series |
| Cortisone | Still covered, shorter relief |
| Physical therapy | Still covered |
| Plan switch | During open enrollment |
Still Covered Treatments
| Treatment | BCBS Coverage |
|---|---|
| Cortisone injections | Yes |
| Physical therapy | Yes (may need PA) |
| Oral medications | Yes (Part D/Rx benefit) |
| Surgery | Yes (when indicated) |
How to Check Your Specific Coverage
Step 1: Review Your Plan Documents
- Summary of Benefits and Coverage (SBC)
- Evidence of Coverage (EOC)
- Medical policy bulletins
Step 2: Call Member Services
Call the number on your BCBS card and ask:
- “Does my plan cover viscosupplementation for knee osteoarthritis?”
- “Is prior authorization required?”
- “Are there any changes planned to this coverage?”
Step 3: Request Pre-Authorization
Before treatment:
- Have your provider request prior authorization
- Get approval IN WRITING
- Understand your cost-sharing
Why This Change Matters
This coverage reduction reflects a troubling trend among commercial insurers, despite:
- FDA approval since 1997
- Medicare’s continued coverage as medically necessary
- Peer-reviewed evidence supporting efficacy
- Millions of patients who benefit from treatment