Can Medicare Cover My Back Brace?
Whether you’re in an accident, or put wear and tear on your back over time, back pain results. Soreness and stiffness in your spine can cause long-term health problems made worse by smoking, overeating, and inactivity. If you have spine conditions like osteoporosis, you could also be prone to vertebrae fractures. Whatever the cause of your back pain, if you have Medicare, you may qualify for a back brace.
Will Medicare Cover the Cost of my Back Brace?
For patients covered by Medicare, back braces could be covered. Medicare can be complicated and confusing, but knowing how your coverage works is important in getting the treatment you need to improve the quality of your life.
Back braces can be used for a wide variety of health benefits. They can help:
- Assist in recovery by immobilizing injured areas
- Improve posture
- Elongate the spine
- Give more comfortability in making movements like standing or sitting down
- Relieve back pain
- Alternate option to surgery
- Stabilize weak areas of the back directly following surgery
If your health care professional prescribed your back brace to be medically necessary, and you’re enrolled in Medicare Part B, your back brace should be covered by Medicare. In the eyes of Medicare, back braces are considered “prefabricated orthotics” and fall under the wide category of DMEPOS. Medicare Part B benefits typically covers durable medical equipment (DME) such as back braces if you meet the requirements discussed below.
Original Medicare (Parts A & B)
When you’re hospitalized and needing DME, Part A hospital insurance covers you. A Medicare supplement could help cover the cost of health care expenses by paying the gaps in Medicare. Part B Medicare covers 80% of your DME or DMEPOS when you meet its criteria. DME supplies must:
- Be prescribed as medically necessary for the patient
- Provide therapeutic use
- Must be used frequently by the patient
- Both the health care provider and DME supplier must accept Medicare assignment
Medigap insurance helps cover the Part B deductible, in addition to the 20% you’d otherwise be responsible to pay. When you select comprehensive coverage, you’re selecting peace of mind.
Medicare Part C and Part D
Many times, you can find a Medicare Part C plan, or Medicare Advantage Plan, that includes prescription drugs. These plans are considered Medicare replacement plans, and they must cover the same services and items covered under Original Medicare.
This means a Medicare Advantage Plan also covers the cost of back braces. Typically they cover the same 80% that Original Medicare covers. You can’t be enrolled in both a Medicare Advantage Plan and a Medicare Supplement.
Many Medicare Advantage plans require you to stay in their network to receive coverage on health care services. Coverage limitations could also apply.
Remember, when you enroll in the Medicare Advantage Plan you will still be responsible to pay your Part B premium each month. You will also be responsible to pay any premium your plan may charge.
Costs for copayments, coinsurance, and deductibles might apply as well; it’s different for each plan. When looking into a Medicare Part C plan, it’s important to double check the doctor network, DME supplier network and prescription drug formulary.
What Do DMEPOS & DME Stand For?
DMEPOS: durable medical equipment, prosthetics, orthotics, and supplies that fall under Medicare Part B coverage (Part A – when hospitalized)
DME: durable medical equipment that also, when medically necessary, falls under Medicare Part B coverage (Part A – when hospitalized)
Both work with your pharmacy through Medicare to ensure you receive the proper medical equipment for your needs.
What Kind of Back Brace is Right for Me?
The proper term for a back brace is lumbosacral orthosis (LSO). The purpose of this brace is to give support for the bony and muscular parts of the spine. One of the more common devices in the Durable Medical Equipment category is the “lumbar back brace.”
LSO is the main brace used to provide stability and restrict certain movements of the spine and torso. These braces are used to treat a variety of conditions.
In order to determine which Medicare back brace is right for you, it is important to contact your physical therapist or doctor to give you proper medical advice based on your medical need.
There are two types of back braces:
- Hard designs
- Soft designs
Hard designs are used to treat more serious conditions like scoliosis and soft, elastic versions (more commonly used) help patients with support or minor injuries.
There are also over 30 styles of rigid and elastic back braces used to treat various spine disorders or injuries.
Depending on if your back brace is covered under your Medicare Part A or Medicare Part B policy, the benefits only cover 80% of the cost. The Medicare beneficiary is responsible for the remaining 20%. Just like majority of durable medical equipment or DMEPOS, back braces can also be costly.
To get your out-of-pocket costs covered, including deductibles, coinsurance and copays, enroll in a Medicare Supplement Plan, or Medigap Plan. These work with your Original Medicare benefits to cover what’s left up to the beneficiary to pay after Medicare pays there share.
Understanding Medicare and how each plan works can help you get access to the medical equipment you need for optimal back and spine health—and pain relief.
Medicare covers the cost of back braces for those who qualify. Choosing the right health care provider or physician, as well as choosing the proper pharmacy to receive your DME or DMEPOS from, will play a factor in the cost as well.