What Are Orthotics?
This article was updated on: 09/15/2018
If you’re a Medicare beneficiary who needs support to help you stand or walk comfortably, Medicare might cover orthotic devices to help support you, such as braces or shoes, in some situations. For example, Medicare Part B may cover orthopedic shoes prescribed for people who suffer from neuropathy (nerve damage, according to the National Institutes of Health). Coverage details depend on what type of orthotic shoes (or other orthotic device) you need, and for which health condition.
Types of orthotics
Here are some examples of different kinds of orthotics:
- Therapeutic orthotic shoes or inserts (typically for those with diabetic foot disease)
- Leg, arm, back, or neck braces to help support these body parts
- Artificial limbs to replace a missing limb, such as one that had to be surgically removed
Coverage for orthotics under Medicare Part B
These are some important things to know about the way that Medicare Part B covers orthotics in general:
- Your doctor must prescribe the orthotic as medically necessary.
- You typically pay 20% of the Medicare-approved expense and the yearly Part B deductible applies.
- Participating medical providers agree to charge no more than the Medicare-approved amount for services and devices, but non-participating providers could charge more with no limit on the amount they can charge you.
- If a supplier does not participate with Medicare (he or she hasn’t signed an agreement with Medicare to always accept Medicare assignment), and charges more than Medicare allows, you could be responsible for these excess charges.
If your doctor prescribes orthotic shoes (or other orthotic devices) for you, you might want to check with Medicare (or your Medicare health plan, such as Medicare Advantage, if you have one) to find out exactly how coverage works in your situation.
Coverage for orthotics under Medicare health plans
If you receive your Original Medicare (Part A and Part B) benefits through a Medicare Advantage plan (except for hospice benefits, which Part A covers), coverage for orthotics must be at least the same as covered under Medicare Part B. You may want to ask your plan for specific details about how your orthotic will be covered under the plan and what you can expect to pay.
If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
If you have a Medicare plan, you can consult with your doctor and your insurance company to find out how much you will have to pay for orthotics or orthotic shoes. You are also welcome to seek help from Medicare by calling 1-800-Medicare or 1-877-486-2048 for TTY at any time. These toll-free phone numbers take calls 24 hours a day and seven days a week.
Are you concerned that your current Medicare benefits won’t cover orthotics, orthotic shoes, or therapeutic shoes very well? If so, I would like to help you maximize your benefits with a plan that can reduce your out-of-pocket costs.
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- To learn more about your local Medicare plan options, click the button below my picture that says, “Compare Plans Now.”