Does Medicare Cover My Back Brace
A back brace is what is considered Durable Medical Equipment or DME. With Traditional insurance, any DME coverage falls under the Part B benefits.
In some cases, your Medicare Part A benefits will cover DM. However, these are your hospital benefits. You must be hospitalized or in home health care in order for your DME to be covered.
For instance, if you’re recovering in the hospital after a spinal surgery such as a kyphoplasty, laminectomy or fusion, and are given a LSO by the surgeon, then your Medicare Part A benefits will provide coverage.
What is the Purpose of a Back Brace
One of the more popular devices in the DME category is a lumbar back brace. 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 aide 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 your a good candidate for the device.
What is Durable Medical Equipment
Durable Medical Equipment, is medical equipment that is used from those suffering from a medical condition who need assistance with daily activities.
The device in question provides therapeutic benefits to patients based on their individual healthcare needs.
Does Medicare Cover Durable Medical Equipment
Under your Medicare Part B, DME is covered at 80%. In some cases Medicare Part A will cover DME. However, you must be hospitalized, and still, only covered at 80%.
Whether using your Part A or your Part B benefits for DME coverage, Medicare has certain criteria that must be met in order for patients to obtain any DME:
The DME must provide durability, meaning the patient can use frequently and has long-term use of the equipment. It must also provide appropriate therapeutic use in the home for the medical condition in which it’s being used for.
And lastly, it must be deemed medically necessary by your physician which can usually be proven through previous office visit notes as well as by obtaining a prescription.
How to Get Help with your Medicare Costs for Back Braces
Whether your LSO is covered under your Medicare Part A or Part B policy, the benefits only cover at 80%. This leaves the Medicare beneficiary responsible for the remaining 20%.
Most DME is quite costly and an LSO is no exception. With only 80% coverage, you will still be financially responsible for some hefty OOP costs for that shiny new brace.
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, it can also help with other costs associated with deductibles, copayments and other OOP costs not covered by straight Medicare.
Let us help you obtain more comprehensive coverage to work alongside your Traditional Medicare benefits so you can have peace of mind.
Call one of licensed insurance agents today for more information or fill out our online form.There is no obligation to enroll and our services are always 100% free.