Table of Contents:
Introduction
Medicare plans offered to beneficiaries cover custom orthotics if they are prescribed for medical conditions and necessitated by a medical expert. While these aids are not completely covered, Medicare policies, including Plan B, cover a huge portion of the medical bill, providing financial relief.
Shoe inserts, knee and ankle braces, footwear modifications, and custom-made shoes are all covered by Medicare. Keep reading to understand the Medicare requirements, its coverages, and other beneficial options for custom orthotics.
Understanding Medicare and Its Coverage
Medicare is a health insurance plan specially crafted for people over 65 years and those with certain serious health ailments. A Medicare plan helps people reduce the burden of paying off the huge amount of fees for hospitalization, doctor consultation, and even surgeries by providing suitable coverage. There are various parts of Medicare, depending on what medical facilities are covered.
Types of Medicare Coverage: Parts A, B, and D
Medicare coverages are further segregated into three types, including parts A, B, and D. Here are the different types and what they offer:
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Part A: This plan provides full hospital coverage for inpatient hospital stays, medical care at home, and even registered nursing facility care. Many people are not required to pay for this plan upon successful payment of Medicare taxes for a specified duration. People can also purchase this plan with a monthly premium if they do not meet the tax requirement.
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Part B: This is also called medical coverage and covers the costs of doctor visits, lab tests, x-rays, preventive tests, and even certain outpatient services. Together with Plan A, it is called Original Medicare.
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Plan D: Plan D provides coverage for prescription drugs. People often have the option to take up Plan D separately or can opt for a Medical Advantage Plan with added coverage of prescription drugs.
Coverage for Orthotics Under Medicare
Orthotics are devices that assist people with foot and ankle issues. These specially designed devices relieve pain and make day-to-day activities more easier and comfortable for patients. Many of these devices include ankle braces and even shoe inserts. Moreover, when recommended by a medical professional, these expenses may be covered under Medicare.
Does Medicare Part B Cover Custom Orthotics?
Medicare plans are divided depending on their coverage, and Plan B covers orthotics as well. Ankle-foot orthoses, knee ankle and foot orthoses are included for benefits under Plan B. Since the cost of these devices may weigh down on the patient, the bills for the devices are covered under Medicare for hospital stays or any registered skilled nursing facility.
Conditions That May Qualify for Coverage
There are certain conditions for the coverage under Plan B. The patient’s conditions should fall in alignment with the following conditions:
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The orthoses must be an ankle-foot or a knee-ankle-foot orthoses.
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It should be a rigid or a semi-rigid device.
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It should support an irregularly formed body part or an injured one.
Requirements for Medicare to Cover Custom Orthotics
Medicare coverage for orthoses is offered only if certain conditions are met. While it is specified that the orthosis must be an ankle foot or a knee ankle foot orthosis, it should also meet other criteria for successful coverage.
Doctor’s Prescription Requirement
The orthosis should be provided to the patient by a registered doctor or a specialist with a proper diagnosis of the ailment. It must be provided to the patient before or during an inpatient hospitalization or a stay at any skilled nursing facility.
Medical Necessity Criteria
The medical necessity of the orthosis must be specified after a hospital stay or an SNF stay. For instance, after an ankle or foot surgery, the patient may be made aware of the necessity.
Limitations of Medicare Coverage for Orthotics
Medicare coverage for orthotics has several limitations, starting from the type of device required to be used to the medical recommendation required. While the device the patient uses must be rigid or at least semi-rigid, it should also be approved during a hospital or SNF stay. This must also be stated clearly in the documentation provided by the doctor.
Types of Orthotics Covered
Braces such as ankle-foot orthoses or knee-ankle-foot orthoses are covered under Medicare Part B. Orthopedic footwear, therapeutic shoes, shoe inserts, and devices used by patients with severe diabetes-related foot diseases are also covered under Medicare Part B.
Coverage for Replacement and Repairs
In case of replacement, people are often advised to contact their Durable Medical Equipment (DME) supplier or Medicare-approved suppliers. Additionally, if the equipment is lost or damaged due to a disaster, Medicare will reimburse the replacement cost based on the submitted documents.
Alternative Ways to Get Custom Orthotics
People can safely get orthotics from any physician or a licensed specialist at a hospital or a skilled nursing facility. A pedorthist or a prosthetist might also be able to customize orthotics for patients.
Supplemental Insurance and Medicaid
Certain insurance policies offer additional coverage for orthotics and can offer discounted prices to beneficiaries. In addition, certain state programs provide Medicaid coverage for orthotics. There may be different eligibility requirements for different states to get registered for the benefits.
Discounts and Savings Programs for Seniors
Numerous discounts are offered to seniors for orthotics. Medicare Part B covers about 80% of the cost of the medically necessary orthotic devices after the deductible is met. In addition, certain retailers also offer discounts to senior citizens on their products and services, depending on their policies.
Final Thoughts
Medicare is a good choice for getting custom orthotics. Whether the patient is a senior citizen or just someone with a chronic ailment, Medicare programs can offer big discounts for expensive treatments and medical products.
Is Medicare the Best Option for Custom Orthotics?
While other options exist in the market for the beneficiaries, medicare stands as one of the most preferred options for custom orthotics. This is specifically due to its larger coverage and flexibility in covering medical procedures, treatments, and even devices used. A large portion of the medical expenses is easily covered by Medicare for patients.
Exploring Other Options for Affordable Orthotics
Since you need to qualify for the medicare policy to avail of the benefits, it is not always readily available. Thus, other options, such as flexible spending accounts and even health savings accounts, which are accounts with tax benefits, might be a good alternative for orthotics coverage. You can even go for employer-sponsored orthotics coverage.
Be sure to check out orthotics products from Stride Soles that offer you premium quality materials at the best rates before you decide on your coverage partner.
