The use of prosthetic devices can be essential for certain patients who have specific medical needs. After an amputation, surgical procedure, or when a certain body part stops functioning and cannot be treated, prosthetic devices can serve as replacement limbs or other body parts. Medicare recipients are offered coverage for some prosthetic devices as long as they are medically necessary, prescribed by a physician, and ordered from a Medicare-licensed supplier.
The Purpose of Prosthetics
Prosthetics come in a range of shapes, sizes, and functions, and they can be used in different parts of the body. These products can be used to replace lost limbs to promote mobility, be implanted into the ears to simulate the functionality of the cochlea to allow for better hearing, and much more.
When you think of prosthetics, there’s a good chance that the first thing you think of is a leg, arm, or hand. However, a prosthetic device is anything that can be used to replace, support, or correct a body part.
Here are a few other examples of prosthetic devices that may be included in your Medicare benefits:
– Breast prostheses and surgical bras
– Contact lenses or eyeglasses after eye surgery
– Cochlear implants
– Other surgically implanted devices
– Urological supplies
– Ostomy bags and other supplies
Medicare Benefits for Prosthetic Devices
Some prosthetic devices are covered for Medicare Part B (Medical Insurance) if they are deemed medically necessary and ordered by a doctor who accepts assignment. The prosthetic device will need to be ordered from a Medicare-approved supplier.
When you receive a prosthetic device that is approved, it is covered by Medicare Part B. If you have Original Medicare, you will likely pay 20 percent of the Medicare-approved amount and the Part B deductible will apply. Many people with Original Medicare choose to purchase a Medigap policy to help cover the costs that Original Medicare does not, including copayments, coinsurance and deductibles. If you have a Medigap policy, it may help cover some of your out-of-pocket expenses related to your prosthetic.
Many Medicare recipients choose to get their coverage through Medicare Advantage, offered by private insurance companies that are approved by Medicare to provide your part A and Part B benefits. If you are enrolled in an MA plan, you will have at least the same coverage as Original Medicare, but many plans offer additional coverage. Check with your plan to find out your exact costs for your prosthetic device.