Does Medicare Provide Coverage For a Knee Brace?

Medicare will generally cover a knee brace when deemed medically necessary by your doctor. This is important for people suffering from knee pain because a knee brace is a viable option to treat many conditions without surgery, or as a post-surgical brace to aid in recovery.

Does Medicare Cover Knee Braces?

Yes. Medicare Part B provides coverage for what's known as Durable Medical Equipment (DME). The coverage includes arm, leg, neck, and back braces, but there are specific stipulations. As aforementioned, your physician will prescribe a knee brace for various conditions related to knee pain. Therefore, if your doctor considers a knee brace medically necessary to treat or manage your condition, some charges for the medical equipment may be covered, but only if you are enrolled in Medicare Part B.

If you haven't enrolled in the Original Medicare Part B or do not have a Medicare Advantage Plan in which a Medicare approved private insurer provides your coverage, Medicare will not cover your knee brace. Some of the perks of most Medicare Advantage Plans offer extra benefits such as Durable Medical Equipment, outpatient surgeries, urgent care, and rehabilitation. To enroll in this plan, you must be within the plan's provider network and have Medicare Part A and Part B.

The most notable benefit offered by many Medicare Advantage plans is prescription drug coverage (Medicare Part D) including home-oriented, non-medical benefits such as transportation, telemedicine, and in-home safety assessments. However, if you enroll in Medicare Part C, be prepared to pay your Medicare Part B monthly premiums. You may also have to pay a deductible, co-payments, and/or coinsurance

Do You Qualify For Medicare DME?

To be covered by Medicare for Durable Medical Equipment, you must meet the following requirements:

1. You may be covered by Medicare insurance if your doctor considers it medically necessary for you to use DME.
2. Your knee brace must be durable and sturdy enough to provide extra stability and support and have an expected lifetime of at least 3-years.
3. Your DME will only be covered if you get it from a Medicare-enrolled supplier that has a unique Medicare Supplier Number (NPI).
4. The knee brace must be used per your prescribing doctor’s recommendation.
5. The prescribed DME will be used in your home.

It's important to note that a knee brace is prescribed as part of an all-inclusive treatment program; therefore, using it without a doctor's recommendation or for prolonged periods may cause more harm than good.

How Much Will It Cost You?

Check with your insurance carrier to see how much deductibles and coinsurance or co-payment you should pay for Original Medicare. As of 2021, you will be required to pay an annual deductible under Medicare Part B. Additionally, if your knee brace comes from a supplier that does not accept Medicare insurance, it may cost you significantly more out-of-pocket for the same brace.

How To Obtain A Knee Brace From Elite Medical Supply

You can use the Elite Medical Supply Medicare Beneficiary Eligibility Lookup tool to determine if you are in an area we service. Simply enter your zip code to find out if you are in an area where we provide knee braces as a Medicare covered benefit.

Our team goes through this simple process to get you a knee brace if you are eligible:

1. Obtain your Medical records from a certified physician detailing your condition.
2. Obtain your Medicare Health Insurance card with Medicare Beneficiary Number (MBN).
3. Our team will check your Medicare coverage status.
4. Once everything checks out, we will give you a rundown of what you are required to pay in terms of co-payments, deductibles, and coinsurance.
5. Elite Medical Supply conveniently ships your brace to your home.
6. We support you with training for your brace.

If you have a prescription and need help with eligibility approval, Contact Us today. Elite Medical Supply will assist you with your paperwork and help you browse our line of high-quality bracing products to find the knee brace that meets all your medical needs.