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An Overview of Medicare Prosthetic Coverage

Medicare Prosthetic Coverage

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The use of prosthetic devices can be vital for patients with certain medical needs. After surgery, amputation, or when a specific body part stops working and can’t be treated, prosthetics can act as replacement limbs or other body parts. Good news. Medicare beneficiaries get coverage for some prosthetic devices — so long as they’re medically necessary, prescribed by a doctor, and ordered from a supplier who has a Medicare license.

What’s the Purpose of Prosthetics?

Prosthetics come in many sizes, shapes, and functions, and people can use them in different areas of the body. Individuals often use prosthetics to replace lost limbs and improve mobility or implant them into the ears to help the cochlea to hear better. 

The term prosthetics might make you think of a “fake” leg, arm, hand. A prosthetic device is anything that you can use to replace, support, or fix a body part. 

What Prosthetic Devices Does Medicare Cover?

Medicare Part B is your medical insurance. According to medicare.gov, Part B covers prosthetic devices required to replace a body part (or function) — when a doctor orders them. Here’s what “prosthetic devices” include:

  • Breast prostheses — including a surgical bra.
  • One pair of eyeglasses or contacts provided following a cataract operation.  
  • Some surgically implanted prosthetic devices, like cochlear implants.
  • Urological supplies — used to manage urinary functions.
  • Ostomy bags and select ostomy supplies.

Note: Ostomy surgery is a serious procedure.

What Are Your Original Medicare Costs?

You pay 20% of the amount approved by Medicare for external prosthetic devices. The Part B deductible applies, which is $198 in 2020. The supplier that furnishes prosthetic devices must be enrolled in Medicare for the items to be covered — no matter whether you or your supplier submits the claim.

Related Post: Medicare Part B Enrollment Information

Note

To see how much your test, item, or service will cost, ask your doctor or health care provider. The amount you’ll owe may vary, depending on these factors:

  • If you have other insurance
  • How much your physician charges
  • Whether your doctor accepts assignment
  • The kind of facility 
  • Where you get your test, item, or service

A prosthetic leg, for example, can cost anywhere from $5,000 — $50,000. Your age, size, health, and the materials also impact the cost.

What Else You Should Know

You need to go to a supplier enrolled in Medicare for Medicare to cover your device.

Part A or B pays for surgically implanted prosthetic devices. It depends on if the surgery occurred in an inpatient or outpatient setting.

What About Medigap?

Many folks with Original Medicare opt to buy a Medicare Supplement (Medigap) policy to help cover what Original Medicare doesn’t — including deductibles, coinsurance, and copayments. If you have a Medigap plan, it may help pay a few of your out-of-pocket costs related to your prosthetic.

How Often Does Medicare Pay for Prosthetic Legs?

Once you reach the Part B deductible, Medicare will pay 80% of the cost. Also, Medicare will cover replacement prosthetics every five years. Additionally, Medicare pays for polishing and resurfacing twice a year. 

Related Post: Medicare Terms That You SHOULD Know

Questions About Medicare? We Can Help

Do you have more questions about what Medicare does or doesn’t cover? View our blog or call Bobby Brock Insurance at (662) 844-3300.

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