Does Medicare Cover Prosthetics?

Medicare Part B may cover prosthetic devices needed to replace a body part or function when a doctor orders the prostheses.

Medicare Advantage (Part C) plans also cover medically necessary prosthetics.

Medicare Advantage plans also include an annual out-of-pocket spending limit. Original Medicare doesn’t include any such spending limit.

A doctor reviews information with his patient in a lobby

Does Medicare cover prosthetic eyes or prosthetic legs?

Medicare Part B (medical insurance) will cover prosthetic eyes if your doctor orders one due to an injury or surgical procedure.

Prosthetic legs are also covered by Medicare Part B if ordered by your doctor.

Some other types of prosthetic devices that Medicare Part B may cover include:

  • Urological supplies
  • Ostomy bags
  • Breast prostheses, including a surgical bra
  • One pair of eyeglasses or contact lenses provided after a cataract operation
  • Some surgically implanted prosthetic devices, including cochlear implants

How much does Medicare pay for prosthetics?

You typically pay 20 percent of the Medicare-approved amount for external prosthetic devices once you meet your Part B deductible.

In 2019, the Part B deductible is $185 per year.

For your prosthetics to be covered, you must go to a supplier who is enrolled in the Medicare program.

If you require a surgically implanted prosthetic device and the surgery takes place in a hospital or other inpatient setting, your hospital costs may be covered by Medicare Part A (hospital insurance) rather than Medicare Part B.

If hospital costs related to your prosthetic device surgery are covered by Part A, your potential out-of-pocket costs may include:

  • Part A deductible: $1,364 per benefit period in 2019

  • Part A coinsurance:
    • Days 1-60 spent in the hospital: $0 coinsurance for each benefit period
    • Days 61-90: $341 coinsurance per day of each benefit period in 2019
    • Days 91 and beyond: $682 coinsurance per each lifetime reserve day after day 90 for each benefit period in 2019
    • Beyond lifetime reserve days: you pay all costs

Medicare Advantage plans can cover prosthetic devices

Medicare Advantage plans are sold by private insurance companies as an alternative to your Part A and Part B coverage. Every Medicare Advantage plan must cover the same services that Original Medicare covers.

In addition to the standard Part A and Part B benefits, most Medicare Advantage plans cover prescription drugs. Some Medicare Advantage plans may also offer additional benefits such as routine dental, vision and hearing coverage.

A licensed insurance agent can help you compare Medicare Advantage plans available where in your area. They can help you find out how your prosthetics may be covered by Medicare Advantage plans where you live.

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