There are many types of prosthetic devices and supplies your doctor may prescribe for you depending on your medical condition. The good news, if you are enrolled in Medicare Part B, is that allowable charges for many prosthetic devices are covered – provided certain requirements are met. If you have questions about your prosthetic device and Medicare coverage, here’s what you need to know.
What are prosthetic devices?
Prosthetic devices replace certain body parts and functions, according to the Center for Medicare & Medicaid Services (CMS).
Some examples of covered prosthetic devices might include:
- Breast implants to restore a normal cosmetic appearance after a mastectomy, or removal of the breast. A surgical bra is also covered.
- Cochlear implants surgically placed to restore hearing in a damaged or diseased ear canal
- Contact lenses to replace a diseased lens after cataract surgery
- Ostomy bags and related supplies after removal of the bladder or a portion of the colon, for example
How does Medicare cover prosthetic devices?
If you’re enrolled in Original Medicare, you might know that there are two main parts to the program. Part A, sometimes called hospital insurance, may pay for care you receive in the hospital as an inpatient. Part B (medical insurance) covers your doctor visits, tests, supplies, and certain care you receive as an outpatient. Medicare covers prosthetic devices under Part B of the program.
Your doctor must accept Medicare assignment, and the medical supplier who provides your prosthetic device must participate in the Medicare program. Otherwise, you may have to pay the full cost of your device and supplies. Usually, Medicare pays 80% of allowable charges and you pay 20% plus any applicable Part B deductible. Medicare also places certain limits on prosthetic devices and supplies specific to each type of device. Contact lenses, for example, are generally covered only after cataract surgery, not for routine vision correction. Your health-care provider can help you determine which prosthetic devices are eligible for coverage.
Some Medicare beneficiaries choose an alternate option to receive their Medicare benefits through the Medicare Advantage (Medicare Part C) program. A Medicare Advantage plan covers everything included in Original Medicare (Part A and Part B) benefits (except for hospice care, which is still covered under Part A), but it often includes other benefits many enrollees appreciate. Most Medicare Advantage plans include prescription drug coverage, and some plans cover routine vision, hearing, and dental care. In other words, you may want to keep in mind that Original Medicare doesn’t cover routine dental checkups (for example), but some Medicare Advantage plans may cover them.
Although you must still pay your monthly Part B premium, and possibly an additional premium for your Medicare Advantage plan, you may like the convenience of getting all your Medicare benefits in a single plan. Costs, like premiums and deductibles, vary among plans. You can compare details of Medicare Advantage plans in your area – just enter your zip code in the form on this page.
If you’d like to know more about coverage for your prosthetic device and supplies, I’d be happy to answer your questions. You can request an email with personalized information just for you, or schedule a phone call at your convenience. Click on the “Get Quotes” button on this page to get started.