Your Medicare Coverage
Is my test, item, or service covered?
Orthotics & artificial limbs
How often is it covered?
- Orthotics, as long as you go to a supplier that’s enrolled in Medicare
- Artificial limbs and eyes
- Arm, leg, back, and neck braces
- Orthopedic shoes only when they're a necessary part of a leg brace
- Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease
All people with Medicare are covered.
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment, you may need to rent the equipment, you may need to buy the equipment, or you may be able to choose whether to rent or buy the equipment.
Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.
Competitive Bidding Program
If you live in or visit certain areas, you may be affected by Medicare's Competitive Bidding Program. In most cases, if you have Original Medicare and get competitively bid equipment and supplies in competitive bidding areas, Medicare will only help pay for these equipment and supplies if they're provided by contract suppliers. Contract suppliers can't charge you more than the 20% coinsurance and any unmet yearly deductible for any equipment or supplies included in the Competitive Bidding Program.
To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.