Paying for Your Prosthetic Device

Are Lower Limb Prosthetics Covered by Medical Insurers?

Employer Plans or Independent Health Coverage Plans

In most cases, medical insurance covers at least part of the expense of a prosthetic limb.

How much coverage you get through an employer's medical insurance for an artificial leg depends on the company, the plan, and a number of other factors.

Some plans pay for everything as long as it's considered medically necessary and after you've met your deductible or covered your copay or co-insurance. Others put limits on how much of the bill they'll pick up. Or they'll limit how often you can replace damaged or defective devices.

A prosthetist bills the medical insurance provider, not only for the device, but also for the proper fit and alignment, all as one total cost. Proper fit and alignment may require several trips to the prosthetist's office.

Medicare Part B 

Medicare Part B covers prosthetic devices needed to replace a body part or function when a Medicare-enrolled doctor or other health care provider orders them.

For Medicare to pay for your prosthetic device, you must go to a Medicare-enrolled supplier. This is true no matter who submits the claim (you or the provider). Visit Medicare.gov for more information.

Medicaid

Medicaid will cover the cost of an artificial leg due to a disability if a physician or healthcare provider states that it's medically necessary.

According to the Kaiser Family Foundation, every state offers prosthesis coverage as a Medicaid benefit even though doing so is optional.

Medicaid programs don't all cover prosthetic devices in the same way or to the same extent. The best way to see how your state handles this kind of coverage is to contact your local agency and ask about it.