Medicare approves braces and devices when medically necessary to treat or maintain a medical condition. Orthotic devices like braces are otherwise known as Durable Medical Equipment. Braces may be used to support the knee, neck, arm, or back. Combining the use of orthotic devices with other treatments may delay the need for a surgical procedure. Benefits and prices may vary among plans. Costs may also change depending on where you purchase the device and the type.
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Does Medicare Cover Back Braces?
The formal terminology for a back brace is lumbosacral orthosis. When a medical condition requires it, all back braces are under Medicare coverage.
Coverage for back braces and supports includes lumbosacral orthoses. The purpose of a lumbosacral orthosis is to support the muscular and bony aspects of the spine.
Medicare-approved back braces such as lumbosacral orthotics may provide extra stability while restricting the movements of the torso and spine.
Does Medicare Cover Lumbar Back Braces?
Darting can hinder or worsen your condition. Back braces are often vital when treating compression fractures and relieving acute and chronic pain.
Back braces help treat a wide range of conditions, and your plan likely covers the cost. Commonly, treatments include post-surgical procedures. ‘
Plans may pay for a lumbar back brace when used to assist the healing process.
Does Medicare Cover Knee Braces?
Part B may cover the costs of knee braces if you meet the criteria set by Medicare. The term durable means the device can handle repeat usage over some time (3+ years). Medicare requires knee braces to provide therapeutic at-home benefits.
As with other devices, your doctor must document an appropriate diagnosis that shows the need for the equipment.
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Your plan may cover an alternative to knee replacement like therapy, using a brace, or injections. Part B covers 80% of the approved amount for Durable Medical Equipment, vaccinations, and therapeutic services.
A prescription from your doctor is generally adequate for coverage. However, in some situations, Medicare may require prior authorization before paying for Durable Medical Equipment.
Every injection comes with a specific cost. Talk to your plan directly to determine the allowable amount for a procedure or injection.
What are the Four Types of Medicare Approved Knee Braces?
Medicare coverage includes four types of knee orthotics. Devices must help manage stability or give pain relief and allow the patient to carry out daily functions.
Rehabilitative – Certain knee braces protect ligaments/tendons after surgery while allowing the joint to move. These rehabilitative devices also protect from potential reinjury.
The Durable Medical Equipment must be a functional and rehabilitative device for coverage to apply. Knee orthotics must also aid a patient’s healing process of joint or neighboring tissue after an injury or surgery.
Functional – A pre-injured knee may be the result of a fall, sporting injury, or trauma to the area. A functional brace provides joint stability for an otherwise unstable knee.
Functional braces offer knee support after an operation. It also may decrease pain and increase performance while wearing the device.
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Unloader or Off-loader – Knee pain is most commonly due to osteoarthritis. Unloader/off-loader braces take the stress off the knee.
Many find pressure relief caused by arthritic joints when using this Durable Medical Equipment.
Such pressure can impact other areas of the leg beside the knee. Unloader braces limit the patient’s side movements, forcing patients to avoid using the areas of the knee joint affected.
Prophylactic – the most common type of knee brace for athletes. High-risk or injury-prone individuals may also need to wear this brace for support.
This type of brace prevents things like ligamentous injuries, which are most common among all knee injuries.
Does Medicare Cover Foot Braces?
A foot or ankle injury may require you to use a foot brace. Coverage is available if your doctor documents it’s medically necessary. Foot braces may be custom or standard – coverage is available for both.
Does Medicare Cover Shoulder Braces?
Yes, Medicare coverage includes all shoulder braces, cradles, supports, and stabilizers.
Does Medicare Cover Neck Braces?
Neck braces may include cervical collars or other neck supporting devices. Cervical traction collars are the exception. Currently, Medicare doesn’t pay for these devices.
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Cervical collars may be either soft or hard. Soft collars are more comfortable; typically, these braces are made of foam, felt, or rubber.
Hard neck supports may keep the head and neck completely still. After invasive surgery or severe neck injury, your doctor may prescribe hard neck support. Soft braces are best following a less strict procedure – for only a few hours each day.
Does Medicare Cover Wrist Support Braces?
Yes, Medicare will cover wrist support braces. Wrist support braces are another type of Durable Medical Equipment. Benefits include all wrist supports, braces, and stabilizers.
Wrist supports may provide some pain relief due to medical conditions such as tendonitis, carpal tunnel syndrome, and other wrist strains or sprains.
Does Medicare Cover Ankle Braces?
Yes, Medicare will help cover the costs of ankle braces. Beneficiaries pay only 20% of the cost for ankle braces with Part B. Benefits may include ankle braces, straps, guards, stays, stabilizers, and even heel cushions.
Acute and chronic ankle or foot pain is a common, everyday use for these devices. Other conditions may benefit from using ankle braces such as ankle instability or osteoarthritis.
How to Get Coverage for Medicare Approved Braces and Devices
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Are finger ring splints for osteoarthritis covered by Medicare? I need multiple splints for both hands
Hi Kelly, if the splint is considered medically necessary by your physician, Medicare should cover those costs.
Had ankle replacement in 2004 now I need a custom made brace or support brace will Medicare pay for it
If a new brace is deemed medically necessary by your physician, it should be covered under Medicare Part B.
Is a stroke recovery arm brace covered?
Hi Gary. Yes, if a brace is deemed medically necessary as a result of a stroke, it will be covered by Medicare.
I received a right knee brace thru Medicare in early 2018. I am now looking at have one for my left knee. Do I need to wait the time frame from receiving the right brace to get the left knee brace.
Roger, there is no time period in place when receiving durable medical equipment. If your doctor orders a brace for your left knee, it should be covered by Medicare.
I broke my big toe two days ago and went to the foot doctor. Confirmed by X-rays my big toe is fractured. The doctor put me in a walking boot to immobilize my big toe for 4-8 weeks. I had some ankle problem on the same foot in April and was given a stretch wrap. Medicare paid for the stretch wrap in April, doctor said Medicare won’t pay for my walking boot for my broken toe because it is the same foot.
Is this correct?
Hi Cathy. You would have to call Medicare directly to find out the answer. There are too many factors to take into consideration for me to give you an accurate answer.
Hi Lindsay- I received an Arizona short brace in February 2020. Today my doctor ordered me to get an Arizona long brace to accommodate my ankle. He claims my foot and ankle are fine, but my foot drop has caused me to walk wrong for many years. The foot drop is coming from my back L4. He is referring me to a neurosurgeon. My Question is: he told me that Medicare only covers 1 brace every 5 years. Are there any exceptions to this rule?
Hi Michele! Yes, there are always exceptions, especially if you’re getting a new brace for a new reason. I would reach out to Medicare directly to find out what documentation your doctor needs to put together for MEdicare. If you have a Medicare Advantage plan, reach out to the carrier directly to find out what your Summary of Benefits says about braces.
I have arthritis in one knee and received a custom knee brace 6 years ago, which was covered by Medicare. I’ve been using it since then, but now it’s in need of refurbishment. I have moved to a different part of the country. What do I need to do to get that done and have Medicare cover it ?
Hi Fred! You would need to talk to your PCP to see what documentation Medicare would need to submit to Medicare. Make sure to get all your medical history from your previous PCP.
I received a temporary knee brace after surgery to keep the knee from bending. I no longer need it. Now I need a permanent brace for stability. Do I have to pay for the new brace?
Hi Joseph! Your new knee brace would fall under Part B since it’s considered Durable Medical Equipment. Part B will cover 80% of the cost, if you have a Medigap plan, it will cover the remaining 20%. If you have a Medicare Advantage plan, they make up their own rules. You would need to reach out to the carrier directly to determine what your out-of-pocket costs would be.
I haven’t received my knee braces I ordered late December of 2020 I have Medicare I was wondering if everything is ok
Hi Alberto! You would want to contact the company you ordered the braces from directly to get the status regarding when you should expect to receive them.