One of the most common questions that our patients ask our prosthetists is whether or not their insurance will cover the cost of their artificial limb. While we would love to provide you with a definitive answer on the matter, but the truth is that many insurance plans vary when it comes to covering prosthetic limbs. The team here at Cornell Orthotics and Prosthetics is always on your side, and we want to make obtaining your prosthetics as easy as possible. This is why we are happy to help coordinate insurance benefits for your care. Below, you will find some general information about some of the most common types of insurance and they type of coverage they typically provide for prosthetic limbs. Questions? Contact our Beverly, MA office today to learn more about our prosthetic services!
Insurance Coverage for Prosthetic Limbs
Employer Health Insurance Plans
Most employer-sponsored health plans cover artificial limbs to a certain extent, thanks to the Affordable Care Act (ACA). The ACA stipulated that small group health insurance plans must cover Essential Health Benefits (EHBs), and prosthetics are included in this category. Large employers are not required to provide coverage, but most do to an extent.
Similar to employer-sponsored health insurance plans, marketplace health insurance will also usually provide coverage for prosthetic limbs in some way. Although this type of insurance has governmental ties, the government does not dictate how much coverage they provide. Regardless of whether you are already enrolled in a marketplace plan or you are shopping around, be sure to do your research since coverage can vary greatly between plans.
Of all the different types of insurance, Medicare is sometimes the easiest to work with. Often times, the cost of artificial limbs is covered, either partially or in full, if your healthcare provider deems they are medically necessary. The Medicare website specifies certain conditions that must be met for coverage consideration and estimates your out-of-pocket expense under Original Medicare.
Every state provides coverage for prosthetic limbs under Medicaid, but the amount of coverage can vary greatly, especially if the state has not expanded its Medicaid program in accordance with the ACA. Thankfully, Massachusetts has a very robust Medicaid program that covers the EHBs we mentioned earlier, allowing many individuals access to the equipment they need.
A Beverly, MA Prosthetist Who Is On Your Side
When it comes to being able to afford your prosthetic limbs and the care associated with them, you can rest assured that Cornell Orthotics & Prosthetics is on your side. While we cannot guarantee how much, if any, coverage your health insurance will provide, we gladly work with many different insurance companies to provide you with the best benefits possible. To learn more, call us at 978-922-2866 today or find additional information about our insurance benefit coordination services online.