What Does Medicare Cover When It Comes to Prosthetic Devices?

While prosthetic devices, including limbs and orthotics, can be costly, they’re an essential part of life for many people. Luckily, in most cases, you don’t have to assume the entire cost for health devices like prosthetics, since you have options when it comes to insurance for prosthetics, and one of these is Medicare. Here’s what you need to know if you’re planning to use Medicare insurance to cover your prosthetic device.

Does Medicare cover prosthetics?

Medicare insurance covers prosthetic devices when they’re deemed medically necessary. Durable medical equipment (DME) is covered under Medicare Part B, and the cost for your device may be completely covered.

There are some requirements that need to be met in order for Medicare insurance to cover your device. Your doctor must specifically deem the device a necessary replacement for a body part or bodily function. There are stipulations for the doctor as well:

  • The doctor must be enrolled in the Medicare program
  • The doctor must describe in detail why you need the device
  • The doctor must confirm that the device is medically necessary

Is there a difference between what Medicare Part A and Part B cover?

There is a difference in coverage between these two common Medicare plans. While Part A provides coverage for devices that require surgical implantation, Part B covers most external prosthetics. You’ll pay a Part A deductible and premium for your device, and you’ll have no copayment for your first 60 days in hospital after your procedure. Part B covers 80 percent of approved equipment costs, and you’ll cover any costs that exceed the maximum amount allowed by Medicare.

What’s considered a prosthetic device?

While prosthetic limbs like arms and legs immediately come to mind, there are many more prosthetic devices that are covered by Medicare. Generally, any item that helps any part of your body that’s been damaged or removed is considered a prosthetic device, including:

  • Eyeglasses or contact lenses after cataract surgery with intraocular lens implant
  • Ostomy bags and other health devices related to bowel procedures
  • Prosthetic limbs and eyes
  • Surgical implants, including cochlear implants
  • Therapeutic shoes and orthotic devices
  • Urological supplies
  • Breast prosthesis, including surgical bras
  • Arm, leg, neck and back braces

What if I have a Medicare Advantage (Part C) plan?

If you’ve chosen a Medicare Advantage (Part C) plan, don’t worry—your plan will typically cover your prosthetic equipment. Part C covers at least as much as original Medicare (Parts A and B). In some cases, you could receive additional coverage with Part C, but always check the details of your plan to learn exactly what’s covered and what you’ll pay out of pocket. Keep in mind, though, that a Part C plan may limit you to receiving services from specific in-network providers depending on the rules of your plan.

If you need a prosthesis, insurance for prosthetics (and specifically Medicare) can help you cover the cost for these medically necessary health devices. Contact Prothotic Laboratories, Inc. to learn more about the process of receiving a prosthetic device and the various coverage options that are available to you.