For people experiencing orthopedic problems like foot pain, osteoarthritis, spinal injury, back pain, or other orthopedic conditions, orthotic devices may provide support and pain relief.
Many physicians prescribe orthotics to aid the healing process after surgeries like hip or knee replacement, or injuries like whiplash. Doctors also prescribe orthotics to relieve pain by keeping a limb immobile. Orthotics are also used to provide extra support for muscles or joints that are either weak or deformed.
Your health care provider may suggest that you get either a custom prescribed orthotic, or a pre-made device to help you with your condition. It is important to have all the facts about how orthotics will help you, if your Medicare benefits cover the costs, and what type of orthotic device is best for you.
How Orthotic Devices Can Help You
“Ortho” comes from the Greek language, and it means straight or correct. Orthotic devices can be splints, braces, or shoe inserts. They support, immobilize, or treat muscles, joints, or portions of the skeleton that have been injured, are deformed, or are too weak to provide proper support.
Podiatrists often prescribe foot orthotics, like shoe inserts, to treat foot problems caused by arthritis, plantar fasciitis, bunions, bursitis, tendinitis, diabetic foot ulcers, or arch or heel pain.
Doctors often prescribe orthotics after common orthopedic surgeries like hip or knee replacement. Orthotics can help support the entire leg and foot for proper alignment, and to avoid foot pronation. In the case of a slight difference in leg length that causes a loss of balance or awkwardness while walking, a custom foot orthotic may correct this.
Spinal orthotic devices include back and neck braces. They stabilize and support areas of the body including the jaw, neck, all regions of the back, and the spine. Doctors prescribe them after surgeries to ensure proper healing. They also prescribe them as treatment for chronic conditions like arthritis, or for injuries such as whiplash.
Medicare Coverage for Orthotic Devices
Medicare Part B pays for 80 percent of the approved cost of either custom-made or pre-made orthotic devices. Of course, this is only possible if your health care provider feels it is medically necessary. Medicare categorizes orthotics under the durable medical equipment (DME) benefit.
Medicare considers durable medical equipment to be equipment used for medical reasons in the home, to have a life expectancy of more than 3 years, and not to be useful to anyone not sick or injured. Medicare lists the following devices as orthotics under the heading of DME:
- Bracing for ankle, foot, knee, back, neck, spine, hand, wrist, elbow
- Orthopedic shoes as a necessary part of a leg brace
- Prosthetic devices like artificial limbs
Medicare recipients must meet all the following prerequisites for eligibility:
- The orthotic must be medically necessary and your health care provider must prescribe it as a component of your complete treatment.
- The supplier of the orthotic must be enrolled in Medicare and accept
Individuals enrolled in Medicare Part B who are eligible for an orthotic device will pay 20 percent of the Medicare-approved cost, and the Part B deductible will apply. In 2019, the yearly Part B deductible is $185.00.
Depending on the type of orthotic you need, costs can range between tens of dollars, up to hundreds of dollars. Prices depend on your location, whether the orthotic is prefabricated or custom-made, as well as the type of device it is. You will need to use a supplier that is participating in Medicare and accepts assignment. Be sure to discuss your best options with your health care provider.