Medicare-approved braces and devices include arm, leg, back, and neck braces. These braces must be considered medically necessary.
Medicare Part B will cover 80% of the Medicare-approved amount. Medicare beneficiaries without a Medigap Plan will be responsible for the remaining 20%, as well as the Part B deductible.
The amount you pay for your brace is dependent on:
- Where you purchase the brace
- Additional insurance you may be enrolled in
- Type of brace needed
In some cases, Part A benefits will cover DME. However, these are your hospital benefits. You must be hospitalized or in-home health care in order for your DME to be covered under Part A.
To get Medicare to cover the purchase of your brace, you’ll have to get a signed prescription from your doctor after a face-to-face exam.
Medicare Coverage for Back Braces and Supports
All back braces and supports are covered by Medicare as long as it’s considered medically necessary. This includes Lumbar Sacral Orthosis (LSO), and TLSO back braces and supports.
The correct terminology for a back brace is lumbosacral orthosis (LSO). The sole purpose of an LSO is to provide support for the muscular and bony structures of the spine.
Additionally, the LSO helps to provide stability and is designed to restrict certain movements of the spine and torso. LSO’s are used to treat a multitude of conditions.
The most common of conditions treated with an LSO are compression fractures however, after post-surgical procedures, the LSO comes in handy to restrict movement and aid in healing.
Benefits of an LSO include pain relief for both chronic and acute pain. It also helps to alleviate pressure off the spine which in turn provides some pain relief with ongoing spine conditions.
As most seniors experience some form of back pain later on in life, an LSO may be beneficial in more ways than one. You would want to talk to your health care provider to see if you’re a good candidate for the device.
Medicare Coverage for Knee Braces
Medicare will cover all knee braces that are found medically necessary.
- Osteoarthritis knee braces
- Post-op knee braces
- CAL/PCL knee braces
- and more
Knee braces are designed to control and stabilize joint movement. This not only reduces pain, but it also prevents further injury & speeds up healing. Knee braces are great for treating sprains, fractures, rheumatoid arthritis, and osteoarthritis.
Medicare Coverage for Shoulder Braces & Supports
Medicare will also cover all shoulder braces, supports, cradles, and stabilizers if they’re found to be medically necessary. Remember, all DME is covered at 80%. The remaining 20% is left up to the beneficiary to pay.
However, if they have a Medicare Supplement Plan, the brace will be covered 100%. The only out of pocket costs a beneficiary may have is the Part B deductible, depending on the Medigap letter plan they have.
Medicare Coverage for Neck Braces
Most neck braces are covered by Medicare. This includes neck braces and cervical collars. However, cervical traction collars are currently not covered by Medicare.
Cervical collars include hard & soft. Hard collars hold the head & neck completely still. Most of the time, they’re used after a serious injury or major surgery.
Soft collars are more comfortable. They’re usually made from rubber, foam, or felt. They allow you to move your heck and neck. These are better used after moderate neck surgery & only a few hours per day.
Medicare Coverage for Ankle Braces
Ankle braces are also covered by Medicare at 80%. This includes ankle braces, ankle brace stays, straps, ankle guards, stabilizers, and heel cushions.
Ankle braces are used for both acute & chronic ankle or foot pain, ankle instability, ankle sprains, personeal tendonitis, proterior tibial tendonitis, and osteoarthritis.
Medicare Coverage for Wrist Braces
Wrist braces are another type of DME that’s covered at 80% by Medicare. This includes all wrists braces, supports, and stabilizers.
Wrist braces will help with pain relief associated with tendonitis, wrist strain or sprain, and carpal tunnel syndrome.
How to Get Help with your Medicare Costs for Braces & Devices
Medicare benefits only cover braces at 80%. This leaves the Medicare beneficiary responsible for the remaining 20%.
Most braces can be quite costly. With only 80% coverage, you’ll still be financially responsible for some hefty OOP costs.
But fear not, there is hope! With a supplement plan, there’s potential coverage to pick up that remaining 20% not covered by Original Medicare.
Not only will a Medicare Supplement Plan help with the OOP costs associated with DME, but it can also help with other costs associated with deductibles, but copayments and other OOP also not covered.
Our agents can help you find more comprehensive coverage to work alongside your Medicare benefits so you can have peace of mind.
Call one of our licensed insurance agents today for more information or fill out our online form.