Depending on certain qualifications, Medicare might pay a portion of the costs for your prosthetic. Medicare covers a variety of prosthetic devices if they are medically necessary by your doctor.
What are prosthetics?
Prosthetics are artificial replacements or substitutes for a part of the body. Prostheses are designed for both functional and cosmetic purposes. Prostheses for joints are typically for the ankle, elbow, hip, knee, and finger joints.
A prosthesis may be removable, such as most prosthetic legs, hand, or breast form used after mastectomy. For someone who uses removable prostheses, they may want to have more than one option available for different types of tasks or as a backup.
Some examples of prosthetic devices include, but are not limited to:
- Artificial teeth
- Facial bones
- Artificial hip
What does Medicare cover?
Your Medicare coverage will depend on several factors. If your prosthetic is surgically implanted, the coverage you receive will depend on where you have the procedure done. If you are an inpatient in a hospital, Medicare Part A will cover all of the costs after you have met your deductible.
If you have outpatient surgery, Medicare Part B will cover the costs of the operation and prosthetics. Part B will also cover any prosthetics that you wear, as long as you get them from a durable medical equipment (DME) supplier that participates in Medicare. After you meet the Part B deductible, you will be required to pay 20 percent of the cost.
Medicare will cover several different types of prosthetic devices, including:
- Artificial limbs
- Breast prostheses after a mastectomy
- Cochlear implants
- Glasses or contact lenses after cataract surgery
- Ostomy bags and supplies
If you have a Medicare Advantage plan, you will need to consult the company that handles your insurance to find out the costs of your procedure and what you will be expected to pay. Medicare Advantage plans are required to cover at least as much as Medicare, but the Medicare Advantage plans are more strict about their network.
Before scheduling any procedures, talk to your doctor about your options and how much it will cost you to avoid any surprise expenses.