What does Medicare cover for back braces?

Back Brace Covered by Medicare: Unlock Benefits

Back pain can result from an accident or simply due to wear and tear on your spine over time. This discomfort can be worsened by unhealthy habits like overeating, smoking, and leading a sedentary lifestyle. Additionally, individuals with conditions such as osteoporosis may be more vulnerable to fractures in the vertebrae of their spines. Fortunately, Medicare beneficiaries suffering from back issues qualify for coverage of a supportive back brace.


Medicare is a federal health insurance program that provides coverage for a wide range of healthcare services, including medical devices and supplies like back braces. However, the amount of coverage provided by Medicare for back braces can vary depending on the specific type of brace, the medical condition being treated, and the individual’s specific Medicare plan.


Will Medicare Cover the Cost of Your Back Brace?


If you’re on Medicare, there’s a good chance your back brace is covered. Understanding how Medicare works can seem daunting, but what matters most is understanding the details of your coverage so that you can receive the treatment necessary to improve yourself and live a better life.


Back braces have an abundance of health advantages, ranging from:


  • Assistance in recovery by immobilizing injured areas.
  • Improving posture.
  • More comfort in making movements like standing or sitting down.
  • Elongating the spine.
  • Stabilizing weak areas of the back after surgery.
  • An alternate option to surgery.
  • Relieving back pain.


If you’ve been prescribed a back brace by your physician and are enrolled in Medicare Part B, then rest assured that Medicare should cover the cost of this medical necessity. Specifically, DMEPOS (Durable Medical Equipment Prosthetics/Orthotics Supplies) falls within the scope of benefits provided by Medicare Part B, including back braces. Simply check to ensure that all requirements set out by Medicare have been fulfilled, and you’ll be good to go.


Original Medicare (Parts A and Part B)

Original Medicare (Parts A and Part B)

When you need hospital equipment and supplies, Medicare Part A will cover your costs. However, if there are any gaps in coverage that Part A does not address, a Medicare supplement plan could help bridge the financial gap. Additionally, when you meet all of the criteria set by Medicine Part B for Durable Medical Equipment (DME) or DMEPOS (Durable Medical Equipment Prosthetics & Orthotics Supplies), then up to 80% of those expenses can be covered as well! Finally, remember DME/DMEPOS must:

  • Provide therapeutic use (e.g., during physical therapy, which is also covered in Medicare B).
  • Be prescribed as medically necessary for the patient.
  • Both the healthcare provider and DME supplier must accept Medicare assignments.
  • It must be used frequently by the patient.


Choosing Medigap insurance can help alleviate worries about paying the Part B deductible and the 20 percent out-of-pocket fees that usually come with it. Comprehensive coverage gives you true peace of mind, knowing all your medical expenses are taken care of.


Medicare (Part C and Part D)

Medicare Part C and Part D

If you look around, you can often discover a Medicare Part C Plan or Medicare Advantage Plan. These plans, which are also known as Medicare replacement plans, must have the same services and items offered by Original Medicare. Most Medicare Advantage plans also cover you for prescription drugs, dental, vision, hearing services, and more.


With a Medicare Advantage Plan, you’re able to obtain coverage for the expense of your back brace that is identical to Original Medicare’s service at 80%. 


Staying within your Medicare Advantage plan’s network is critical to receive full coverage for health care services. Restrictions may apply, so always read the coverages carefully and familiarize yourself with any limitations of your policy beforehand.


Moreover, you can only alter your Medicare Advantage Plan annually, except for a select group who qualify for a special election period.


What Do DMEPOS & DME Stand For?


DMEPOS: When admitted to the hospital, durable medical equipment, prosthetics, orthotics, and supplies are all covered by Medicare Part A. Those same items that don’t require a stay in the hospital (such as regular checkups) fall under the coverage of Medicare Part B.


DME: Durable medical equipment that is medically necessary may be covered by Medicare Part B (or, if you are hospitalized, Part A) reimbursement.


Both the medical supplier and your doctor will collaborate to provide you with the appropriate and specific back brace requirements.


Read More: How Orthotics Help Reduce Back Pain?


What Kind of Back Brace Is Right for You?


The official title for a back brace is lumbosacral orthosis (LSO), which provides the spine with sturdy, muscular support. Lumbar back braces are among the most prevalent types of durable medical equipment available.


LSO braces are the ideal solution for increasing stability and preventing and managing spinal or thoracic conditions. Before getting a Medicare back brace that’s suitable for you, it is essential to contact your doctor so they can provide expert medical advice for your specific requirements.


When it comes to back braces, there are two main varieties:


  • Hard designs
  • Soft designs 


Rigid back braces are utilized to address more severe cases such as scoliosis, while elastic varieties can aid in providing support for milder injuries. With over 30 forms of rigid and soft support available, patients can access a range of solutions tailored to their individual needs.

Discovering Helpful Tips

Medicare Part A and Medicare Part B policies both offer coverage for back braces. Back braces can be pricey, like many other pieces of durable medical equipment, so it’s important to check your eligibility in advance. You can contact Artik Medical Supply to check eligibility for free and in minutes.  


Enrolling in a Medicare Supplement Plan or Medigap plan may reduce the amount you have to pay out-of-pocket, including deductibles, coinsurance, and copays. These plans work with your Original Medicare benefits to cover any additional costs after Medicare pays their share. Understanding how each of these plans works can provide access to necessary medical equipment for back and spine health and pain relief from chronic conditions.


If you qualify, Medicare will cover the cost of your back brace. However, to ensure that you pay as little out-of-pocket expense as possible, it is essential to select the right healthcare provider and medical supplier for your durable medical equipment (DME) or DMEPOS.


The Bottom Line

In general, Medicare covers a variety of back braces, including lumbar and thoracic braces, as well as scoliosis braces. However, Medicare will only cover a back brace if it is prescribed by a doctor and is deemed medically necessary for the treatment of a specific medical condition.


Additionally, depending on your specific Medicare plan, you may be required to pay a deductible, copayment, or coinsurance for the back brace.


If you have questions whether a specific back brace will be covered by Medicare or the cost of a back brace under Medicare, you can contact Artik Medical Supply to check eligibility for free and in minutes. 

© 2022 ARTIK Medical Supply. All Rights Reserved.