Beneficiaries must meet certain requirements before Medicare will cover the costs of prosthetic devices.
Devices and supplies come in all shapes and sizes. Your healthcare provider may prescribe any of these to you depending on your medical condition. The option to use prosthetic devices can be vital for those with specific medical needs.
Of the 330 million U.S. citizens, 2.1 million people across the country are living with limb loss today. As the population continues to grow, this number will increase. The cost of limb loss can be financially exhausting.
In fact, lifetime healthcare costs for an amputee is roughly $509,000, making the cost of living $150,000 more than those without limb loss. Fortunately, there are coverage options available to those who qualify. What are Prosthetic Devices?
The Center of Medicare and Medicaid Services (CMS) classifies and defines the term prosthetic devices. Stating that any device(s) or artificial substitute that can replace certain body parts and/or functions that may have been lost due to disease, trauma or congenital conditions (birth defects).
Patients are using prosthetic devices for both cosmetic and functional reasons. Technological advances and new discoveries are being found all the time.
The way prosthetic devices are advancing is no exception. New devices are giving patients the option of customizing them, allowing patients to feel more like themselves.
Examples of devices range from artificial teeth, eyes, facial bones, the palate, artificial hip, knee and other joints, legs, arms, and more.
How Medicare Covers Permanent Prosthetic Devices
When you think of these devices, what comes to mind? Usually a prosthetic arm, hand or leg, etc. However, permanent devices generally require surgery or procedure. Medicare may cover these costs depending on the circumstance.
If a procedure or service is medically necessary, Medicare will likely cover it. Medicare covers procedures for breast implants to give back the normal cosmetic appearance after a mastectomy (full removal of the breast) procedure. They also cover the costs of surgical bras.
Coverage for after a cataract surgery includes one pair of contact lenses or conventional eyeglasses to replace the diseased lens. Also including, certain surgically implanted prosthetic devices like, cochlear implants.
Cochlear implants will help restore hearing in an ear canal with disease or damage. Medicare covers costs for urological supplies and ostomy bags/supplies.
Coverage includes for those patients who’ve had their bladder, or a portion of their colon taken out. Part B will cover these costs, unless, the patient resides in an inpatient facility. In this case, Part A will cover the costs.
Advancing Prosthetic Devices
Moreover, advances in technology for prosthetic devices are changing lives every day. Some of the incredible advancements include allowing athletes to continue playing their favorite sports. Giving patients the mobility, proper weight, rotation, suspension (etc.) with prosthetic legs/arms!
Growth in the medical science field is revealing that a few experiments are in the works. Using prosthetics and integrating them with body tissues, as well as the nervous system.
Prosthetic devices are advancing in great ways. Testing shows response to commands sent from the central nervous system. What does this mean? These devices can simulate human movement and utility better than ever before. Big news!
Many common prostheses for joints include the knee, ankle, elbow, hip as well as finger joints. Some prosthetic implants (devices) can be only parts of a joint like a unilateral knee. Arthroplasty is another name for joint replacement.
Prosthetic devices may be removable or permanent depending on the circumstance. For instance, removable prosthetic devices might be necessary like artificial legs, arms, hands, etc.
Let’s use Tom for an example. Tom needs an artificial hand. He wants and more-so needs more than one type of hand. Reason being, not all prosthetics are made the same; they certainly don’t perform the same way.
Having prosthetic options is very beneficial for patients. This will allow them to carry out different daily functions or tasks properly.
Permanent prosthetic devices are surgical implants. They’re not removable like the artificial limbs/hands. Some of the more common permanent prosthetic devices include dental implant(s), an artificial hip, and a procedure where they attach an artificial limb directly to the bone.
Medicare Covers Some Cost of Prosthetic Devices
If you’re an Original Medicare beneficiary, it’s likely that you already know there are two main parts of the Original Medicare Program.
Medicare Part A is your hospital insurance. This is because Medicare Part A may cover the cost of care or services that you receive during your stay at an inpatient facility.
Medicare Part B is your medical insurance. Part B covers costs for doctor visits, testing, supplies, and certain services that you may receive while in an outpatient setting.
Medicare Part B outpatient settings such as your doctor’s office or another outpatient facility. Part B covers the cost of prosthetic devices when the patient is using them at home.
When Medicare Covers
For Medicare to cover the cost for prosthetic devices, beneficiaries must meet certain requirements before coverage begins.
First, your healthcare provider or doctor must accept Medicare assignment. Next, the medical supplier that provides you with a prosthetic device(s) must also be a participant of the Medicare program.
If either of these providers refuses to accept Medicare, you may be responsible for the full cost of your supplies and/or device(s).
For qualifying situations, Medicare pays 80% of the charges allowable. You’re responsible to pay the remaining 20%. In addition, beneficiaries must pay any Part B deductible.
Medicare does have limitations on certain prosthetic devices and relating supplies for each kind of device. For instance, Medicare provides coverage for contact lenses or eyeglasses after cataract surgery. On the other hand, Original Medicare doesn’t provide coverage for routine vision correction.
Medicare Advantage Plans
Of course, Medicare beneficiaries still have another option. The alternative, which is to acquire Medicare benefits through a supplement Insurance plan (Medigap), or a Medicare Advantage (MA) or Medicare Part C program.
MA plans must include everything that Original Medicare (Part A and B) includes. In addition to the Original Medicare benefits, many MA plans offer additional benefits. These include routine vision and dental, hearing and prescription drug coverage.
The extra benefits may be appealing to some enrollees. The best plan for you depends on your specific health needs.
Costs of premiums and deductibles will be different according to the plan chosen, as well as the area you live in.
If a Medicare Advantage plan is the plan you think is right for your healthcare needs, be sure you understand your financial responsibility.
You must still pay your monthly Medicare Part B premium in addition to, the premium cost for your MA plan. Medicare enrollees like this plan because of the convenience of receiving all their Medicare benefits in one single plan.
Get Help Paying for Medicare Prosthetic Devices
Any questions about eligibility for coverage of prosthetic devices should first start with your doctor or healthcare provider. Start by talking with your healthcare professional. Your doctor can discuss some of your options pertaining to your health condition and needs.
You have 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 will compare plan prices, answer questions and help you in the right direction. Our services are of no cost to you. Why wait? Give us a call today at the number listed above or fill out an online rate form.