Does Medicare Cover Knee Braces?
Unravel Medicare's approach to covering knee braces. Understand the requirements, process, and financial aspects of obtaining support.
Knee braces serve as medical devices providing support, stability, and pain relief for various conditions affecting the knee joint. These devices can be an important part of a treatment plan, aiding in recovery from injury or surgery, or managing chronic conditions.
Medicare Coverage for Knee Braces
Medicare generally covers knee braces as Durable Medical Equipment (DME) under Medicare Part B. For a knee brace to be covered, it must be considered medically necessary. This means a physician or other healthcare provider must prescribe the brace to treat or diagnose an illness, injury, condition, or its symptoms, and it must meet accepted standards of medicine.
Durable Medical Equipment includes items that withstand repeated use, are used for a medical reason, are primarily for sick or injured individuals, are used in the home, and are expected to last at least three years. Both custom-fitted and off-the-shelf knee braces can be covered if they meet the medical necessity criteria. The brace must be prescribed by a Medicare-enrolled doctor or other healthcare provider and obtained from a Medicare-enrolled supplier.
Recent policy discussions indicate an expansion in coverage for knee orthoses used to treat osteoarthritis. These braces may be covered even without documented joint instability, provided conditions like pain or functional impairment are present and the patient is willing to use the orthosis. This reflects an ongoing effort to align coverage with current clinical practices.
Steps to Get Your Brace
Obtaining a Medicare-covered knee brace begins with a visit to your doctor or other healthcare provider. Your provider will assess your condition and, if medically appropriate, issue a prescription or order for the knee brace. This prescription serves as crucial documentation for Medicare coverage.
After receiving a prescription, the next step involves finding a Medicare-enrolled supplier. Confirm the supplier is Medicare-enrolled and, ideally, “accepts assignment.” When a supplier accepts assignment, they agree to accept the Medicare-approved amount as full payment for the brace. This arrangement helps limit your out-of-pocket costs, as the supplier cannot charge you more than the Medicare-approved amount, aside from your coinsurance and deductible. The supplier will also directly submit the claim to Medicare on your behalf.
Understanding Your Costs
Under Original Medicare Part B, after meeting the annual deductible, you pay 20% of the Medicare-approved amount for the brace. For 2025, the Medicare Part B annual deductible is $257. This deductible must be met before Medicare begins to pay its share of costs for Part B services, including durable medical equipment.
If you obtain a knee brace from a supplier who does not accept assignment, your costs may be higher. These suppliers can charge more than the Medicare-approved amount, and you are responsible for any excess charges beyond the 20% coinsurance. You might also pay the entire bill upfront and then seek partial reimbursement from Medicare yourself. Supplemental insurance, such as a Medigap policy, can help cover some or all of the Part B deductible and coinsurance amounts.
Coverage Through Medicare Advantage
Medicare Advantage plans, also known as Medicare Part C, provide an alternative way to receive Medicare benefits through private insurance companies. These plans are required to cover at least all the benefits that Original Medicare (Parts A and B) covers, including medically necessary knee braces.
However, Medicare Advantage plans may have different rules, networks, and cost-sharing structures compared to Original Medicare. This means that while coverage is provided, your specific out-of-pocket costs, such as deductibles, copayments, or coinsurance, could vary depending on your plan. These plans may also require you to use in-network suppliers or obtain prior authorization for certain equipment. It is advisable to contact your specific Medicare Advantage plan directly to understand their detailed coverage rules, network requirements, and anticipated costs for knee braces.