Does Medicare Pay for Orthotics? The Surprising Truth Revealed

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Orthotics are devices that support, correct, or improve the function of a part of the body.

They can be splints, braces, shoe inserts, or artificial limbs.

Orthotics can help people with various orthopedic problems, such as foot pain, arthritis, spinal injury, or back pain. But does Medicare pay for orthotics? The answer may surprise you.

In this article, we will explain the types, benefits, and costs of orthotics, and how Medicare covers them.

Does Medicare Pay for Orthotics? In this article, we will reveal the truth about Medicare coverage for orthotics.
Does Medicare Pay for Orthotics? In this article, we will reveal the truth about Medicare coverage for orthotics.
Contents show

What Are Orthotics and How Do They Help?

An infograpic on orthotics benefits
An infograpic on orthotics benefits

Orthotics are custom-made or pre-made devices that are prescribed by a doctor or a podiatrist to treat a specific condition. Orthotics can help by:

  • Providing support and stability to a weak or injured body part
  • Correcting or preventing deformities or malalignment
  • Relieving pain and inflammation
  • Improving mobility and function
  • Enhancing healing and recovery

Types of Orthotics

An infographic on types of orthotics
An infographic on types of orthotics

There are different types of orthotics for different parts of the body, such as:

  • Foot orthotics, such as shoe inserts, insoles, or arch supports. They can help with foot problems like plantar fasciitis, bunions, bursitis, tendinitis, diabetic foot ulcers, or arch or heel pain.
  • Ankle-foot orthotics, such as braces, boots, or casts. They can help with ankle problems like sprains, fractures, or arthritis.
  • Knee orthotics, such as braces, sleeves, or straps. They can help with knee problems like osteoarthritis, ligament injuries, or meniscus tears.
  • Back orthotics, such as belts, corsets, or vests. They can help with back problems like scoliosis, herniated discs, or spinal stenosis.
  • Neck orthotics, such as collars, braces, or halos. They can help with neck problems like whiplash, cervical spondylosis, or spinal cord injury.
  • Spinal orthotics, such as braces, rods, or screws. They can help with spinal problems like fractures, deformities, or tumors.
  • Hand-wrist orthotics, such as splints, gloves, or rings. They can help with hand-wrist problems like carpal tunnel syndrome, arthritis, or tendonitis.
  • Elbow orthotics, such as braces, slings, or bands. They can help with elbow problems like tennis elbow, golfer’s elbow, or bursitis.
  • Shoulder orthotics, such as braces, slings, or harnesses. They can help with shoulder problems like rotator cuff injury, dislocation, or arthritis.
  • Prosthetic devices, such as artificial limbs, eyes, or ears. They can help with amputation, congenital defects, or trauma.

How Does Medicare Cover Orthotics?

Medicare Part B covers 80% of the approved cost of either custom-made or pre-made orthotic devices, as long as they are medically necessary and prescribed by a doctor or a podiatrist.

You are responsible for paying the remaining 20%, plus the Part B deductible. Medicare also covers the fitting, adjustment, repair, and replacement of orthotics, as long as they are done by a Medicare-approved supplier.

However, Medicare does not cover all types of orthotics. For example, Medicare does not cover:

  • Foot orthotics, unless they are an integral part of a leg brace or you have severe diabetic foot disease
  • Orthopedic shoes, unless they are attached to a leg brace or you have severe diabetic foot disease
  • Over-the-counter orthotics, unless they are modified by a doctor or a podiatrist
  • Orthotics that are not durable, reusable, or used for medical purposes

To get Medicare coverage for orthotics, you need to:

  • Have a prescription from a doctor or a podiatrist that specifies the type, size, and frequency of use of the orthotic device
  • Get the orthotic device from a Medicare-approved supplier that accepts Medicare assignment
  • Follow the instructions and guidelines for using and maintaining the orthotic device

How Much Do Orthotics Cost?

The cost of orthotics depends on several factors, such as:

  • The type, size, and quality of the orthotic device
  • The complexity and customization of the orthotic device
  • The provider and supplier of the orthotic device
  • The insurance coverage and copayment for the orthotic device

The average cost of orthotics ranges from $200 to $800 per pair.

Custom-made orthotics are usually more expensive than pre-made orthotics, as they require more time, materials, and expertise.

However, the cost may vary depending on your specific condition, needs, and preferences.

If you have Medicare, you can expect to pay 20% of the approved cost of the orthotic device, plus the Part B deductible.

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Conclusion

Orthotics are devices that can help you with various orthopedic problems, such as foot pain, arthritis, spinal injury, or back pain.

Medicare Part B covers 80% of the approved cost of either custom-made or pre-made orthotic devices, as long as they are medically necessary and prescribed by a doctor or a podiatrist.

You are responsible for paying the remaining 20%, plus the Part B deductible.

However, Medicare does not cover all types of orthotics, and you need to get them from a Medicare-approved supplier that accepts Medicare assignment

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