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Prosthetic Devices

Covered by Medicare

Coverage

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.

Your Medicare Part A and Part B will cover your prosthetic, but how will depend on several factors. If your prosthetic is surgically implanted, the coverage you receive will depend on where you have the procedure done.

Medicare Advantage plans are required to cover at least as much as Medicare, but the Medicare Advantage plans are more strict about their network. Contact the company in charge of your plan to get specifics on your coverage.

Costs

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.

What to Know

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

Medicare By State

Medicare is regulated by the federal government. However, private insurance companies are allowed to offer various parts of Medicare, and these plans can differ from state to state.

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