How to determine eligibility for medicare knee brace coverage?

Knee Braces Covered by Medicare: Check Eligibility

If you’re an older adult and need a knee brace, then you might be wondering if Medicare will cover the cost. The good news is that Medicare does cover knee braces. However, some criteria must be met to qualify for coverage. Let’s look at what those criteria are and how you can determine your eligibility.

How Does Medicare Cover Knee Braces? 

First, knowing what kind of knee braces Medicare will cover is essential. Generally speaking, Medicare covers braces that are considered medically necessary to treat specific conditions such as arthritis or other joint-related issues. These include off-the-shelf braces and custom-fitted braces that provide support and stability.


Medicare usually covers knee braces if your doctor deems them medically necessary. This is important for people suffering from knee pain. Knee braces are viable for treating many conditions without surgery or as post-operative braces to aid recovery.


Medicare Part B covers what is known as Durable Medical Equipment (DME). The term durable means that a device can be used repeatedly over a period of time (3 years or more). Part B covers 80% of the approved value for durable medical devices. Coverage includes arm, leg, neck, hip and back support, but there are certain conditions. As mentioned above, doctors prescribe knee braces for a variety of issues related to knee pain. 


Medicare will not cover your knee brace if you are not enrolled in your original Medicare Part B or have a Medicare Advantage Plan with coverage provided by a Medicare-approved private insurance company. Most Medicare Advantage Plan benefits include additional benefits such as long-lasting medical equipment, ambulatory surgery, emergency care, and rehabilitation. To enroll in this plan, you must be part of the plan’s provider network and have Medicare Part A and Part B coverage.


What Are the Four Types of Medicare-Approved Knee Braces?


Medicare coverage includes four types of knee braces. These devices provide stability, relieve pain, and allow patients to perform their daily tasks.

Four Types of Medicare-Approved Knee Braces


Specific knee braces protect ligaments, tendons, and tissue after surgery or a severe injury while still allowing joint movement. These rehabilitation devices also protect against potential re-injury.


A previously injured knee can result from a fall, injury, or trauma to the area. A functional brace helps stabilize an otherwise unstable knee joint.


A functional brace also provides knee support after surgery. It can also reduce pain and improve performance while wearing the device.

Unloader or Offloader 

Safe and secure support softens the knees. Since knee pain is most commonly caused by osteoarthritis, a durable medical device provides relief from the pressure in arthritic joints.


This pressure can affect other areas of the leg other than the knee. Unloader or offloader braces restrict the patient’s lateral movement and force the patient to avoid using the affected part of the knee joint.


This is the most common type of knee brace for athletes. High-risk and injury-prone individuals may also need to wear this brace for support.


This type of brace prevents ligament damage, the most common of all knee injuries.


How Do You Qualify for Medicare DME?


To be eligible for durable medical equipment through Medicare, you must meet the following requirements:

  • If your doctor determines that DME use of a knee brace is medically necessary.
  • Knee braces should be durable and robust enough to provide added stability and support and are expected to last at least three to five years.
  • Durable medical equipment is only covered when received from a Medicare-registered supplier with a unique Medicare Supplier Number (NPI).
  • Knee braces should be used as recommended by the prescribing physician.


It’s important to note that knee braces are prescribed as part of a comprehensive treatment program. Therefore, using one without a doctor’s recommendation or for a long time may cause harm.


How Much Does a Knee Brace Cost?

Check with your insurance company what deductibles, coinsurance, or copayments may be required. Medicare Part B has an annual deductible. Additionally, if the knee brace is from a provider that does not accept Medicare insurance, the same brace can cost significantly more. 


If you do have Medicare Part B, that will cover 80% of the cost of long-term medical equipment. If you have a Medicare Advantage Plan, you can cover the total cost of a knee brace without out-of-pocket expenses.

What Are the Income Limits for Medicare Part B in 2023?

The fees you pay for Medicare Part B and D in 2023 are based on the income reported on your 2021 tax returns. Individuals with incomes of $97,000 or less and joint claimants with incomes of $194,000 or less do not need to pay additional fees for Part B or Part D.


Read More: Balance Braces To Give You Your Life Back


How To Obtain A Knee Brace From Artik Medical Supply


Our team will support you through a simple process to help provide you with a knee brace.

  • First, we will verify you basic information
  • Next, we will verify your Medicare health insurance card with your Medicare Beneficiary Number (MBN).
  • Our team checks your Medicare coverage and eligibility.
  • Artik Medical Supply sends a request to your primary care doctor. 
  • If a brace order is approved for medical necessity, Artik Medical Supply ships the brace conveniently to your home. 
  • We provide support, fittings and training on the proper use of your brace. 

Contact us today if you need help checking your eligibility in advance. Artik Medical Supply will help you with the paperwork, our quality orthotic products and communicate with your doctor to help you find the knee brace that meets all your medical needs.

The Bottom Line

In summary, determining Medicare knee brace coverage can seem daunting at first glance, but it doesn’t have to be!


For a quick eligibility check, contact Artik Medical Supply. We can communicate with your doctor/healthcare provider. With us, you can quickly determine if you qualify for coverage and the associated costs. Stop living in pain and get started today!


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