Does Medicare Cover My Back Brace?
This article was updated on: 10/20/2018
Your doctor may prescribe a back brace for various conditions that might cause lower back pain. If your doctor considers a back brace medically necessary to manage or treat your condition, and you’re enrolled in Medicare Part B, allowable charges for your back brace may be covered under your Part B benefits.
Part B is part of Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance). Some people choose to delay enrollment in Part B (for example, if they’re covered by an employer’s plan). If you don’t have Part B coverage (or Medicare Advantage, described below), Medicare doesn’t cover back braces.
What kind of back brace should I get?
Your doctor or health-care provider will prescribe the back brace he or she thinks will best treat your injury or condition. Back braces come in various types, according to the Center for Medicare & Medicaid Services, and might be rigid or elastic (or a combination of both).
When does Medicare cover a back braces?
Medicare considers back braces to be “prefabricated orthotics,” which fall into the broad category of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Durable medical equipment such as back braces are generally covered under your Part B benefits if you meet the requirements described below.
Usually, Medicare will pay 80% of allowable charges for your back brace and you pay 20% plus any unpaid Part B deductible, provided that your doctor accepts Medicare assignment and your medical device supplier participates in the Medicare program. Your doctor must prescribe the brace as medically necessary.
You may be eligible for the Medicare Advantage program (Medicare Part C), which is an alternative way to get your Medicare benefits. These plans must cover all the same services and items covered under Original Medicare, although hospice care is still covered under Part A. So Medicare Advantage plans may also cover back braces, and they often include other benefits, such as coverage for prescription drugs and routine vision care.
If you elect to enroll in a Medicare Advantage plan, you will still pay your Part B premium each month, in addition to any premium the plan may charge. Other costs such as copayments, coinsurance, and deductibles may also apply – these vary among plans.
Want to know more about Medicare coverage for your back brace or other devices? I’m happy to help you; click the “View Profile” link to learn more about me. Request an email or schedule a phone call by clicking one of the links below for help when it’s convenient for you. You can also find out about plans in your area you may qualify for by clicking the “Compare plans” button below.