Does Medicare Cover Knee Braces?7 minute read
7 minute read|
Updated for December, 2018
Knee braces are an important piece of equipment in an elderly person’s life, especially those with arthritis. Knee braces are covered by Medicare under Part B, just like many other orthotics such as arm, leg, and back braces.
However, acquiring and using a knee brace is not as simple as going to the store, picking one out, and getting reimbursed for it later. You must first understand which type of brace you need, how to get one that’s right for you, which braces are and aren’t covered, and how much you’re going to end up paying for it.
Before we cover that, let’s talk about why someone may need a knee brace.
What are Knee Braces Used For?
Knee braces are used to help support, stabilize, and rehabilitate the knee when it becomes difficult and painful to walk and move around. They help shift weight from the problem area of the knee to the healthy part. Or, if the whole knee is an issue, a brace helps alleviate pressure all over.
The largest cause of knee problems in elderly people is osteoarthritis, which is the most common form of arthritis in America. Around 30 percent of seniors suffer from the condition, and the most-affected joints are the knees. Other leading causes including trauma to the knee and bone spurs.
Osteoarthritis occurs when the padding between joints in your body, such as your knees, wears down over time and causes the joints to rub together. This causes pain, swelling, reduced range of motion, discomfort, and a clicking or cracking sound, according to the Arthritis Foundation. Osteoarthritis makes the simple act of moving around on your feet difficult and painful.
This is where knee braces can help. They have four main functions:
Relieving pain and pressure:
This is the primary function of knee braces for the elderly, especially those with arthritis. They can help take the pressure off the joint and reduce pain. In doing this, an elderly person’s independent mobility can increase.
Stabilize the knee:
If an elderly person injures their knee, a knee brace can help stabilize the area, especially after surgery. Tendons and other structures in the knee need to be stabilized in order to recover, and a knee brace can help with that process.
Rehab the knee:
Once the knee is stabilized, knee braces can be used to help the knee regain function. While this type of brace also provides stability, it helps make sure the knee is properly healing during the rehab stage.
Athletes make up the majority of people who use knee braces as part of a prevention plan. However, elderly people may use also them if they’re at a higher risk of injuring their knee(s).
Your doctor will have to sign a form saying that you need a knee brace in order for you to get one partially paid for by Medicare.
Which Knee Braces are Covered by Medicare?
Medicare will cover rigid or semi-rigid knee braces. They’re covered because they’re considered durable medical equipment with the presumption that the brace will hold up for at least three years. This is why sleeves, bandages, straps, and wraparound braces aren’t covered—they most likely won’t last more than three years with daily use.
In order have a brace covered by Medicare, it must be deemed medically necessary that you need one, which means you need it to help treat or manage a condition. Your doctor will have to sign a form saying that you need a knee brace in order for you to get one partially paid for by Medicare.
If you want to get a sleeve, wraparound, or other style of brace for a more mild knee condition, you can; it just won’t be covered by Medicare. You can acquire these braces in retail stores or online. If you don’t need a hinged knee brace yet, ask your doctor which style is best for you.
How Much Will I Have to Pay for a Knee Brace?
Knee braces are covered under Part B of Medicare, which means that 80 percent of your costs for the durable medical equipment will be covered. You will have to pay the remaining 20 percent once your deductible—$183 for Part B as of 2018—is fully paid for the year. If you have a Medicare Advantage plan, the full cost for knee braces may be covered without any out-of-pocket costs.
It’s difficult to determine exactly how much you will end up paying out-of-pocket because knee braces come at varying costs. They range anywhere from less than $100 (for the more mild cases of arthritis) to more than $1,000.
This is where your doctor can help. He or she could have recommendations for affordable, effective knee braces that will be covered by Medicare. Also, your doctor could also send you to an orthotics specialist who can help fit you for a custom knee brace.
If you have any questions regarding knee braces, how to get them, or which ones are covered by your plan, contact your primary care physician, an orthotics specialist covered by Medicare, or your local Social Security Administration office.