Medicare covers a variety of prosthetics if they’re necessary to replace a body part or function. Examples of prosthetics range from artificial teeth, eyes, facial bones, the palate, artificial hip, knee and other joints, legs, arms, and more. Below we’ll discuss WHICH prosthetics have coverage and HOW Medicare covers them.
Medicare Approved Prosthetics
Medicare covers many types of prosthetics, including:
- Artificial limbs
- Breast prostheses after a mastectomy
- Cochlear implants and certain other types of surgically implanted prostheses
- Ostomy bags and supplies
- Eyeglasses or contact lenses after cataract surgery
Medicare Approved Prosthetic Devices
Medicare will provide coverage for prosthetic devices such as enteral and parenteral nutrition equipment & supplies, ostomy supplies, tracheostomy care supplies, urological supplies, cardiac pacemakers, speech aids, scleral shells, etc. Since each situation is unique to the beneficiary, talk with your doctor to see how much Medicare will cover.
Does Medicare Cover Prosthetic Legs?
Yes, Medicare will cover a prosthetic leg. Part B will cover the cost of the surgery if it’s done in an outpatient setting. If it’s done in an inpatient setting, then Part A will cover it.
You must get your prosthetic leg from a supplier that participates in Medicare. You’ll pay 20% of the cost, plus the Part A or Part B annual deductible. If you have a Medigap plan, it will help cover most, if not all, of your cost-sharing.
How Much Does a Prosthetic Leg Cost?
Further, the costs can vary depending on if you use other insurance, a facility that doesn’t accept Medicare, and your doctor’s fees. Discuss costs with your doctor beforehand.
How Much Does a Prosthetic Arm Cost?
Part B covers prosthetic arms the same as legs. You pay the premium and meet the deductible. Then, you pay 20% of the costs.
Like prosthetic legs, there is a wide array of options for prosthetic arms. Costs can range from around $3,000 to $30,000.But, advanced myoelectric arm costs fall around $20,000 to $100,000 or more depending on the technology. Medicare may not pay for advanced features if they’re not necessary.
If you want a 3D printed arm custom fit in about 40 hours, Open Bionics has the cost of the “Hero Arm,” starting around $3,000. But, they don’t have a clear indication of insurance acceptance.
Since they have private clinics, I imagine the costs are all out of pocket. Although, if you’re spending that much on a prosthetic even with coverage, that might be something to consider.
Does Medicare Cover Cranial Prosthetic?
Medicare doesn’t cover hair prosthesis unless it’s necessary for treatment. Since a wig won’t improve your health condition, it’s unlikely that insurance will cover any costs.
But, the cost of wigs for people going through cancer can be a tax-deductible expense, so save those receipts! Further, if you have an Advantage plan, you may get reimbursement for one wig.
Does Medicare Cover Cochlear Implants?
Medicare covers cochlear implants to improve hearing. Implants work differently than hearing aids. Cochlear implants can cost as much as $100,000 without insurance, but you can expect to pay much less if you have Medicare. Part B covers implants inserted in a healthcare provider’s office or outpatient facility.
Medicare will pay 80% of the Medicare-approved rate for the implants and surgery. If you have Medigap, that policy picks up the other 20%.
Does Medicare Cover Prosthetic Eyes?
Medicare covers prosthetic eyes if your doctor orders them. Part B will cover the surgical procedure to insert the implant into the orbital socket. Once you meet the Part B deductible, Medicare pays 80% of the cost.
Medicare will also cover replacement prosthetics every five years. In addition, Medicare covers polishing and resurfacing twice each year.
Does Medicare Cover Breast Prosthetics?
Medicare covers surgically implanted breast prostheses after a mastectomy. Part B also pays for external breast prostheses, bras, and post-surgery camis.
But, you must buy from a supplier that participates in Medicare. External breast prostheses need replacement periodically, and Medicare will pay for replacement devices.
Medicare adheres to this coverage schedule:
- One silicone breast form every two years, or one foam breast form every six months
- If you had surgery on both breasts, Medicare would pay for two
- Mastectomy bras with a doctor’s prescription have coverage for about 4-6 bras each year
- Medicare may cover new bras because of changes in your weight or other reasons
- Up to three camis a month, if necessary
Does Medicare Cover Custom Breast Prostheses?
Medicare covers standard external breast prostheses. It won’t pay for custom versions, even for women having trouble with off-the-shelf products.
But, legislation has been introduced in Congress that would provide coverage. As of now, there is a CPT Code for custom breast prosthesis, but coverage isn’t available yet.
Get Help Paying for Medicare Prosthetics
You have Medicare coverage options for prosthetics and any relating supplies that are unique to your situation. We can help you! Our team can find a plan that fits your health and budget needs. We’ll compare plan prices, answer questions, and help you in the right direction. Give us a call today at the number above or fill out an online rate form to get started.