How to Find Medicare-Approved Back Braces
- Medicare covers back braces if your doctor says you need one for medical reasons. Learn more about how much Medicare will pay for durable medical equipment such as back braces.
If you need a back brace because of an injury, surgery or condition, it may be covered by your Medicare insurance. Below is a look at how and when Medicare provides coverage for back braces.
How Back Braces Are Covered by Medicare
Back braces are categorized as durable medical equipment, or DME. Durable medical equipment consists of products and items used for medical purposes, such as crutches, wheelchairs, braces and more.
Items classified as DME are covered by Medicare Part B.
Because Medicare Advantage (Medicare Part C) plans are required by law to include all of the same basic benefits as Medicare Part A and Part B, back braces are also covered by Medicare Advantage plans.
When Will Medicare Cover Back Braces?
There are certain criteria that must be met in order for back braces to be covered by Medicare as durable medical equipment:
- The back brace must be prescribed for use by a Medicare-approved physician.
- The back brace must be durable – meaning it can withstand repeated use – and have an expected lifetime of at least three years.
- The back brace must be used for a medical reason.
- The back brace must not be considered equally useful to someone who is not sick or injured.
- The back brace must be used in the home. It can of course be used outside of your home as well, it just needs to meet the requirement of not being only used in a hospital or other professional health care provider setting.
- The back brace must be supplied by a provider who accepts Medicare.
How Much Does Medicare Pay for a Back Brace?
Medicare Part B requires an annual deductible of $203 per year in 2021. Once you meet your deductible, you’re then typically responsible for a coinsurance payment of 20% of the remaining costs of covered care and items such as your back brace.
If you have a Medicare Advantage plan, your plan may feature deductibles and coinsurance or copayment requirements that are different from Original Medicare (Part A and Part B). Check with your plan carrier to see exactly how much your back brace will cost.
If you receive your back brace from a supplier who is enrolled in Medicare but does not accept Medicare assignment, they may be allowed to charge you up to 15% more for the back brace than the Medicare-approved amount. This added cost is called an “excess charge.”
If you have a Medicare Supplement Insurance (also called Medigap) plan, you may have full or partial coverage of the Medicare Part B coinsurance requirement, depending on which type of Medicare Supplement plan you have. This means you’ll likely pay nothing for your back brace after you meet your annual Part B deductible. Depending on which Medigap plan you have, you may also receive full coverage of any Part B excess charges.
Where to Find Back Braces Covered by Medicare
Medicare strives to make it easy to find a back brace supplier who accepts Medicare insurance.
Enter your zip code in the supplier lookup tool on Medicare.gov. Then check the box for “Orthoses: Prefabricated” and click the search button.
If you have questions about Medicare’s coverage of back braces or need further assistance in locating a supplier, call 1-800-MEDICARE (1-800-633-4227) or speak to your doctor.