One of the biggest topics we discuss with beneficiaries is Medicare coverage for knee braces. Knee braces, along with any other orthotic device, is what the medical community calls Durable Medical Equipment or DME. Whether you’re obtaining DME for your knee or other areas of the body such as the spine, wrist or ankle, its purpose is to provide treatment for a sprain/strain injury or osteoarthritis.
Orthotic devices can be purchased at most medical supply stores, provided from your doctors office or in some cases are customizable from an orthotist. An orthotist specializes in the design, customization and fitting of your DME device.
Whether your device is custom-made or not, the purpose of your brace is to help guide, control, limit and immobilize movement of the knee joint all while trying to diminish pain. When used in conjunction with other conservative treatments, a knee orthosis can prolong if not completely alleviate surgical intervention.
Medicare Coverage for Knee Braces
DME coverage primarily falls underneath your Medicare Part B benefits as long as it’s deemed medically necessary by your treating physician. Additionally, Traditional Medicare benefits require certain criteria that must be met in order for the Part B benefits to pick up coverage.
- Knee braces must be functional and rehabilitative
- It must facilitate the healing process following an injury to the joint or surrounding tissues.
- It must facilitate the healing process following a surgical procedure
- It must be considered, “durable”, so it can withstand multiple uses over a prolonged time (> 3 years)
- It must provide therapeutic benefits for at home use
- You must have a prescription from your healthcare provider with an appropriate diagnosis for which you are needing the orthotic device
Prophylactic (preventative) braces are not covered by Medicare benefits as they’re considered experimental. In some cases, Medicare Part A benefits will pick up coverage of DME however, this is only if your currently hospitalized while given the brace. For example, if your surgeon provides you with a post-op knee brace after having a total knee replacement (TKA), then your hospital, Part A benefits, will provide payment for the device.
Whether using your inpatient, Part A or outpatient, Part B benefits, Medicare will only cover 80% of the Medicare allowable costs. These leaves the remaining 20% coinsurance left for the Medicare beneficiary responsible to pay.
Types of Knee Braces
There are 4 typical types of knee orthotics that help maintain stability, provide pain relief and allow for continued daily function:
Rehabilitative Knee Braces:
This type of brace helps with stabilizing the knee joint while healing from an injury or recent surgery. After surgery, rehabilitative braces help to protect the repaired ligaments and/or tendons while also allowing joint movement. The device also protects against reinjury.
Functional Knee Braces:
A functional knee brace is used for an already injured knee whether it’s from a sporting injury, fall or trauma to the knee. The main goal of a functional knee brace is to provide joint stability for an unstable knee. It also provides additional support post-operatively, decreases pain and enhances performance all while wearing the orthosis.
Unloader/Offloader Knee Braces:
These braces treat the most common cause of knee pain, osteoarthritis (OA). This type of brace “unloads” stress. It also alleviates pressure from the arthritic joint by placing pressure onto the other surrounding areas of the leg. This brace limits side movement forcing the patient to avoid using the affected area of the knee joint.
Prophylactic Knee Braces:
This type of brace prevents injury and most commonly is worn by athletes or high-risk patients susceptible to a traumatic knee injury. It can also be worn for a ligamentous injury which is the most common type of knee injury.
Get Help with Medicare Coverage for Knee Braces
While 80% of your medically necessary knee brace will be covered, that remaining 20% leftover can easily add up. Depending on which type of brace your medical provider recommends, it can cost upwards of $1,000.00. As most seniors have some form of OA and are typically on a fixed income, even $50.00 extra for the out of pocket (OOP) expense of a brace can leave one strapped.
Seniors, don’t be alarmed if you require a brace as there is hope! A Medicare Supplement Plan provides additional medical coverage. It works alongside your Traditional Medicare benefits to pick up those costs not covered by straight Medicare benefits.
Depending on your individual healthcare needs there are a variety of different plans available and we can help tailor the perfect insurance package beneficial to you.
5 Fun Knee Facts
Did you know?!
- You can walk without your kneecap. In cases where someone shatters their kneecap (partially or entirely), their kneecap continues to dislocate, or they have severe arthritis, it may be recommended that they have kneecap removal surgery. Although it sounds intense, you’d still be able to walk afterwards. The only difference is you’d have to wear protective gear when kneeling!
- A flamingo’s knees bend backwards.
- The first record of the use of the phrase “the bee’s knees” dates back to the 18th Century.
- Humans are the only species of primate that walk on two legs all of the time. Our knees are designed to fully extend and “lock” into place. Because most primates’ knees don’t operate like ours, they have to use a shocking amount of muscle power to support their body weight on two legs, so they mostly get around on all fours.
- Every time you take a step your knees are bearing 3x your bodyweight, and up to 5x if you’re walking down stairs or downhill.
Who knew these 5 fun facts about knees?!
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