If you have been suffering from foot discomfort, custom-fitted orthotics could provide a way out. These specialised shoe inserts can alleviate foot and gait problems to give you back your life – and Medicare covers them under Part B as durable medical equipment!
For Medicare assignment to apply, you will require a valid doctor’s prescription and select an eligible supplier who accepts orthotics medicare coverage Adelaide to help reduce costs.
Eligibility
Medicare will cover up to 80 percent of the costs for shoe orthotics (braces, splints, or inserts that support, immobilise or treat damaged muscles, joints or parts of the skeleton) that are medically necessary. This coverage comes under its DME coverage or durable medical equipment and prosthetics benefit.
Certain private employer health insurance plans also cover orthotics; according to a survey from the Society for Human Resource Management, 75% of large employer plans and 70% of smaller ones do this.
Your best bet for orthotics coverage should always be to visit the website of your insurance company and review their coverage offerings, or look in your Summary of Benefits and Coverage document. Most plans require you to meet a deductible before healthcare expenses will be covered, though this varies between providers. Also keep in mind that certain orthotics are considered over-the-counter (OTC), which might not be covered under your plan.
Requirements
Many patients are misinformed regarding Medicare’s coverage for orthotics. We must inform them of the facts; Medicare only covers foot orthotics (HCPCS Codes L3000 and L3020) under one specific circumstance – when they form part of an integral leg brace.
This means they should fit snugly to the leg brace with minimal self-adjustment required, be prescribed by a physician as part of an overall treatment plan and purchased from a supplier who accepts assignment of claims through Medicare.
Medicare refers to this equipment as durable medical equipment (DME). However, not all insurance providers offer orthotics medicare coverage Adelaide of DME devices; thus, it’s crucial that consumers conduct extensive market research before making any definitive decisions or speaking with licensed agents before making their choice. Also visit our comprehensive guide of health insurance to gain more knowledge.
Coverage
Of those suffering chronic foot pain, most are likely wondering whether their health insurance will cover the costs of custom-fitted orthotics – as these specially made shoe inserts have proven extremely helpful at relieving discomfort and increasing comfort and mobility.
Medicare Part B typically covers most of the costs associated with orthotics. This is because these devices fall under durable medical equipment (DME or DMEPOS; Durable Medical Equipment Prosthetics Orthotics and Supplies). However, please be aware that only those who possess both a valid doctor’s prescription for them and a DME supplier enrolled with Medicare will qualify.
Original Medicare (Parts A and B) includes deductibles and coinsurance rates that must be met before coverage becomes effective, so those enrolled in private health plans approved by Medicare can find out more by speaking directly with their insurer about coverage options.
Costs
Insurance policies vary; some provide coverage for orthotics while others do not; however, Medicare Part B does cover this specialised shoe insert as part of its durable medical equipment (DME) benefit.
Orthotics are rigid or semi-rigid devices worn on the body to support, align, protect, or improve joint, limb, or spine function. Orthotics are often employed in treating conditions like plantar fasciitis – an acute heel pain condition – where supportive devices cannot.
Individuals requiring orthotic shoes or inserts should expect their orthotics medicare coverage Adelaide to cover some of the expenses, subject to applicable deductibles and coinsurance charges. Medicare beneficiaries are strongly encouraged to consult a licensed insurance agent when selecting the most appropriate plan for them and their budget – they’ll also help make sure benefits are maximised during annual enrolment periods! Contact us now and connect with an agent!