Does Medicare Cover Back Braces?

Back braces can be very beneficial to seniors with injuries or chronic conditions that cause pain. Professionally fit back braces recommended by your doctor can provide a safe and non-invasive solution to your condition. With guidance from your physician regarding time worn and specific exercises, wearing a back brace can have many positive benefits, including:

  • Assist in the healing process after an acute injury
  • Decrease the chance of further injury
  • Help control pain and discomfort
  • Support weakened muscles
  • Promote good posture

High quality braces can be costly, but Medicare may help cover the cost of a back brace.

Medicare Part B Coverage for Back Braces

Medicare Part B (Medical Insurance) covers medically necessary back braces under the durable medical equipment (DME) prefabricated orthotics benefit. Your Medicare-approved physician must prescribe the back brace and it must meet specific DME criteria. The brace must be durable, used for a medical reason, not useful for someone who is not sick or injured, used in your home, and must have an expected lifetime of at least three years.

If you have Original Medicare, you will pay 20% of the Medicare approved amount of the brace as long as the supplier is enrolled in Medicare and accepts assignment. The Part B deductible still applies. If the supplier is enrolled in Medicare but is not “participating,” they can choose not to accept assignment. If the supplier does not accept assignment, there is no limit to the amount they can charge you.

If you are enrolled in a Medicare Advantage plan, such as an HMO or PPO, you will have at least the same Part B coverage as Original Medicare, but many MA plans offer additional coverage. Your costs will depend on which plan you choose. If you are in a Medicare Advantage plan and require a back brace, call your plan to find out how much you’ll have to pay.