Does Medicare Cover Knee Braces?
- Does Medicare cover knee braces? Find out about Medicare coverage for orthopedic devices, and about how your benefits help manage the cost of outpatient care.
Yes. Medicare helps tens of millions of Americans pay most of the cost for knee braces, orthopedic devices and other outpatient needs. Under Original Medicare, these benefits are grouped under the optional Part B benefit, while Medicare Advantage participants typically get their outpatient services under the same plan as their hospital benefit. You may have to pay a monthly premium and annual deductible before Medicaid benefits can help with the cost of a knee brace, but necessary medical appliances and durable goods are usually part of your Part B coverage plan.
How Much Does a Knee Brace Cost?
The cost of knee braces varies according to several factors. Some braces are relatively simple in design and don’t cost very much, while others have to be customized to fit your leg and can come with a high price tag. In the United States, the typical cost of a knee brace from a major brand runs between $20-$30 for something simple to a few hundred dollars for a fitted device. Some knee braces are available off the shelf for less money than this, while specialized devices can cost up to several thousand dollars. Your Medicare benefits typically only cover the braces your doctor decides you need, and then only for the knee braces you get through a Medicare-approved supplier. Braces you buy off the shelf are not generally paid for by Medicare.
How Medicare Benefits Work for Knee Braces
Original Medicare divides its coverage plans into different parts, called A, B and D. Medicare Part A is an inpatient hospital benefit, and Part D helps pay for prescription medication at the pharmacy. Knee braces and other orthopedic devices are paid for under Part B, the outpatient benefit. Under Part B, you pay a monthly premium for your plan and an annual deductible before your benefits kick in. In 2021, the Part B standard deductible is $203. After these costs, Part B pays up to 80% of the list price of the knee brace your doctor has authorized.
If you get your benefits through a Medicare Advantage plan, sometimes called Medicare Part C, your inpatient and outpatient benefits are combined into a single plan. These plans are issued through private insurance companies, and some variation exists between states and specific plans. Your basic Part C plan can provide all of the same benefits for paying for knee braces that Original Medicare usually would under Part B. Ask your plan provider about the details of your coverage and the likely costs you have to pay out of pocket.
Your Costs Under Medicare Part B
If you get your knee brace through Original Medicare Part B, you are likely to pay some money out of pocket for the durable medical equipment you need. After paying your monthly premiums and the annual deductible, you may have to pay up to 20% of the Medicare-approved price of the knee brace. This is called the coinsurance amount, and it applies to most Part B items and services.
Many people carry a Medicare supplemental insurance policy to help pay for that 20% cost. Medicare supplements are privately issued insurance policies that are designed to work with your existing Medicare coverage and reduce the amount you pay at the point of service. Coverage details vary with the specific plan you have, but some plans pick up all of the out-of-pocket costs left by the standard Part B coverage limits. Some Medicare Advantage plans include 100% coverage for these costs. Ask your plan provider about your coverage costs and limits.
Getting Extra Help
Many Medicare beneficiaries have to fit their medical share of cost into a fixed income, which can be a challenge even when Medicare covers 80% of the cost of a knee brace. If you need extra help paying for orthopedic devices, you have a few options:
- Medicaid can pick up most or all of the unpaid costs of medically necessary knee braces. If you are dual-eligible for Medicare and Medicaid, your Medicaid plan can act as a supplemental coverage policy. In this case, Medicaid pays the remaining cost after your Medicare benefits reach their limit.
- Many medical suppliers offer discounts to people with limited ability to pay their coinsurance costs. Ask your doctor or the device retailer about low-income discount programs that might be available.
Speak with your doctor about your ability to pay for the cost of the knee brace. While a less expensive brace may not be the ideal choice, your doctor may be able to recommend a more affordable device that is just as effective, if price is a concern.