Medicare approves braces and devices when medically necessary to treat or maintain a medical condition. Orthotic devices like braces are otherwise known as Durable Medical Equipment. Braces may be used to support the knee, neck, arm, or back. Combining the use of orthotic devices with other treatments may delay the need for a surgical procedure. Benefits and prices may vary among plans. Costs may also change depending on where you purchase the device and the type.
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Does Medicare Cover Back Braces?
The formal terminology for a back brace is lumbosacral orthosis. When a medical condition requires it, all back braces are under Medicare coverage.
Coverage for back braces and supports includes lumbosacral orthoses. The purpose of a lumbosacral orthosis is to support the muscular and bony aspects of the spine.
Medicare-approved back braces such as lumbosacral orthotics may provide extra stability while restricting the movements of the torso and spine.
Does Medicare Cover Lumbar Back Braces?
Darting can hinder or worsen your condition. Back braces are often vital when treating compression fractures and relieving acute and chronic pain.
Back braces help treat a wide range of conditions, and your plan likely covers the cost. Commonly, treatments include post-surgical procedures. ‘
Plans may pay for a lumbar back brace when used to assist the healing process.
Does Medicare Cover Knee Braces?
Part B may cover the costs of knee braces if you meet the criteria set by Medicare. The term durable means the device can handle repeat usage over some time (3+ years). Medicare requires knee braces to provide therapeutic at-home benefits.
As with other devices, your doctor must document an appropriate diagnosis that shows the need for the equipment.
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Your plan may cover an alternative to knee replacement like therapy, using a brace, or injections. Part B covers 80% of the approved amount for Durable Medical Equipment, vaccinations, and therapeutic services.
A prescription from your doctor is generally adequate for coverage. However, in some situations, Medicare may require prior authorization before paying for Durable Medical Equipment.
Every injection comes with a specific cost. Talk to your plan directly to determine the allowable amount for a procedure or injection.
What are the Four Types of Medicare Approved Knee Braces?
Medicare coverage includes four types of knee orthotics. Devices must help manage stability or give pain relief and allow the patient to carry out daily functions.
Rehabilitative – Certain knee braces protect ligaments/tendons after surgery while allowing the joint to move. These rehabilitative devices also protect from potential reinjury.
The Durable Medical Equipment must be a functional and rehabilitative device for coverage to apply. Knee orthotics must also aid a patient’s healing process of joint or neighboring tissue after an injury or surgery.
Functional – A pre-injured knee may be the result of a fall, sporting injury, or trauma to the area. A functional brace provides joint stability for an otherwise unstable knee.
Functional braces offer knee support after an operation. It also may decrease pain and increase performance while wearing the device.
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Unloader or Off-loader – Knee pain is most commonly due to osteoarthritis. Unloader/off-loader braces take the stress off the knee.
Many find pressure relief caused by arthritic joints when using this Durable Medical Equipment.
Such pressure can impact other areas of the leg beside the knee. Unloader braces limit the patient’s side movements, forcing patients to avoid using the areas of the knee joint affected.
Prophylactic – the most common type of knee brace for athletes. High-risk or injury-prone individuals may also need to wear this brace for support.
This type of brace prevents things like ligamentous injuries, which are most common among all knee injuries.
Does Medicare Cover Foot Braces?
A foot or ankle injury may require you to use a foot brace. Coverage is available if your doctor documents it’s medically necessary. Foot braces may be custom or standard – coverage is available for both.
Does Medicare Cover Shoulder Braces?
Yes, Medicare coverage includes all shoulder braces, cradles, supports, and stabilizers.
Does Medicare Cover Neck Braces?
Neck braces may include cervical collars or other neck supporting devices. Cervical traction collars are the exception. Currently, Medicare doesn’t pay for these devices.
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Cervical collars may be either soft or hard. Soft collars are more comfortable; typically, these braces are made of foam, felt, or rubber.
Hard neck supports may keep the head and neck completely still. After invasive surgery or severe neck injury, your doctor may prescribe hard neck support. Soft braces are best following a less strict procedure – for only a few hours each day.
Does Medicare Cover Wrist Support Braces?
Yes, Medicare will cover wrist support braces. Wrist support braces are another type of Durable Medical Equipment. Benefits include all wrist supports, braces, and stabilizers.
Wrist supports may provide some pain relief due to medical conditions such as tendonitis, carpal tunnel syndrome, and other wrist strains or sprains.
Does Medicare Cover Ankle Braces?
Yes, Medicare will help cover the costs of ankle braces. Beneficiaries pay only 20% of the cost for ankle braces with Part B. Benefits may include ankle braces, straps, guards, stays, stabilizers, and even heel cushions.
Acute and chronic ankle or foot pain is a common, everyday use for these devices. Other conditions may benefit from using ankle braces such as ankle instability or osteoarthritis.
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Kayla Hopkins
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Kayla Hopkins is an accomplished writer and Medicare enthusiast serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
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Medicare Coverage for Braces and Devices
Medicare approves braces and devices when medically necessary to treat or maintain a medical condition. Orthotic devices like braces are considered Durable Medical Equipment (DME). They may be used to support the knee, neck, arm, or back. Combining the use of orthotic devices with other treatments may delay the need for a surgical procedure. The coverage, benefits, and prices of these devices may vary among plans and can also change depending on where the device is purchased and the type.
Back Braces (Lumbosacral Orthosis): All back braces, including lumbosacral orthoses, are covered by Medicare when a medical condition requires it. The purpose of a lumbosacral orthosis is to support the muscular and bony aspects of the spine .
Knee Braces: Medicare Part B may cover the costs of knee braces if the criteria set by Medicare are met. The device must be durable and provide therapeutic at-home benefits. A prescription from a doctor is generally adequate for coverage, and the device must handle repeat usage over some time (3+ years).
Four Types of Medicare Approved Knee Braces: Medicare coverage includes four types of knee orthotics: rehabilitative, functional, unloader or off-loader, and prophylactic. Each type serves specific purposes related to managing stability, providing pain relief, and aiding in the healing process after an injury or surgery.
Foot Braces: Medicare coverage is available for foot braces if a doctor documents that it's medically necessary. Both custom and standard foot braces are covered.
Shoulder Braces: Medicare coverage includes all shoulder braces, cradles, supports, and stabilizers.
Neck Braces: Medicare covers neck braces, except for cervical traction collars. Cervical collars may be either soft or hard, and the coverage varies based on the type of brace prescribed by a doctor.
Wrist Support Braces: Medicare covers wrist support braces, which are considered Durable Medical Equipment. These braces may provide pain relief for conditions such as tendonitis, carpal tunnel syndrome, and other wrist strains or sprains.
Ankle Braces: Medicare helps cover the costs of ankle braces, with beneficiaries paying only 20% of the cost with Part B. These braces are beneficial for acute and chronic ankle or foot pain, ankle instability, or osteoarthritis.
In summary, Medicare provides coverage for a wide range of braces and devices when they are medically necessary to treat or maintain a medical condition. The coverage and specific requirements for each type of brace are determined by Medicare guidelines and the individual's medical needs.
Conclusion
Medicare coverage for braces and devices is an important aspect of healthcare for individuals who require orthotic support for various medical conditions. Understanding the coverage and requirements for different types of braces can help individuals make informed decisions about their healthcare needs. If you need assistance in finding the right Medicare plan for your needs, you can reach out to MedicareFAQ for personalized help and guidance.
