Does Medicare Cover Orthotic Devices?
Orthotics are specially designed and fitted medical devices that support, align, relieve, and correct many orthopedic problems. Supportive orthotics help patients heal after an injury or surgery, reduce pain in a limb by reducing its movement, and support joints and muscles that are weak or malformed.
Medicare Benefits Solutions
Jan 14, 2022
If a health care provider has prescribed an orthotic for you, you most likely have coverage assistance through your Medicare benefits. Here’s a look at how your Medicare insurance helps you pay for the orthotics you need.
How does Medicare cover orthotics?
Medicare categorizes orthotics as durable medical equipment (DME) and is included in your Medicare Part B coverage. There are many different types of orthotics – both custom-made and prefabricated. Medicare Part B covers the following types of orthotics:
- Bracing devices for ankles, feet, and knees
- Bracing for the back, neck, or spine
- Bracing for hands, wrists, and elbows
- Orthopedic shoes that aren’t an integral part of a leg brace
- Various prosthetic devices that include artificial limbs and eyes
Medicare benefits eligibility
To be eligible for this Medicare benefit, you must meet the following requirements:
- Your physician must certify that the orthotic is medically necessary to treat your condition. The physician must prescribe the orthotic as part of a treatment plan for the condition.
- Your prescribing physician and the durable medical equipment supplier who provides the orthotic must accept Medicare assignment.
Original Medicare pays for 80 percent of the final approved cost to rent or purchase an orthotic device. Medicare recipients pay the remaining 20 percent of the cost and are also responsible for covering their Part B deductible for the year.
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Medicare Advantage plan coverage
If you have a Medicare Advantage (Part C) plan from a private insurance company, you are entitled to coverage for orthotics if you meet the same qualifications mentioned above. Depending on the type of Medicare Advantage plan you have, your plan may restrict your coverage to a set network of health care providers, medical suppliers, and medical facilities.
Your plan may require that you rent or purchase your durable medical equipment from a specific DME supplier in your service area. Because it’s possible your plan won’t cover your orthotics if you use a DME supplier outside the plan’s network, make sure you have this information before making an appointment with a supplier.
Your out-of-pocket cost for your orthotics depends on the copayment or coinsurance set by your Part C plan. Even though your plan must provide all benefits included in Original Medicare Parts A and B, they have the right to set the amount of coinsurance for durable medical equipment and other benefits.
Does Medicare cover therapeutic shoes and shoe inserts?
If you have diabetes and diabetic foot disease, Medicare Part B covers the following items on an annual basis:
- One pair of shoes and inserts that have been custom-molded and fitted
- One pair of extra-depth shoes that have been fitted on you
- Two additional pairs of inserts for custom-molded shoes
- Three pairs of inserts for extra-depth shoes
- If you don’t want the inserts, Medicare covers shoe modifications instead.
To qualify for this benefit, you must get your shoe prescription from a health care provider, and the shoes from a supplier, who accept Medicare assignment. Medicare pays for 80 percent of the final approved cost of the shoes and inserts. You pay the remaining 20 percent and your Part B deductible.
If you have Medicare Advantage, your out-of-pocket costs depend on your individual plan. Check with your plan provider to get information about your coinsurance amount and which DME suppliers are within the plan’s network before you make your appointments.