Does Medicare Cover Elbow Braces ?

Does Medicare cover elbow braces ? Yes, Medicare Part B typically gives 80% coverage to “medically necessary” elbow braces prescribed by a Medicare-enrolled doctor and acquired from a Medicare-approved supplier at the Medicare-apporved price.

Medicare qualifying guidelines for elbow braces

To get your elbow brace covered under Medicare Part B you will need to have a face-to-face appointment with a Medicare-enrolled doctor, who will have to certify that it is “medically necessary” for you to have one, and that you will benefit from the brace, for which the doctor will give you a signed prescription.

To qualify, you must need an elbow brace for one of the following reasons –

• to stabilize the elbow because of a weakness or deformity
• to restrict movement of the elbow joint because of an injury or disease
• to facilitate healing following a surgical procedure

If you satisfy one of the above conditions, the doctor will give you a signed prescription, and you can take this to a Medicare enrolled-supplier to choose your model of brace.

Medicare-approved elbow braces ?

You are allowed to choose from, either Custom Fitted, or Off-The-Shelf elbow braces with coverage under Medicare part B.

The difference between the two types of braces –

Custom Fitted Braces –

Custom fitted braces require fitting by a certified Orthotist, as they may demand an important amount of modification during the fitting process to make the best possible fit.

Off-The-Shelf braces –

Off-The-Shelf braces should only require minimal adjustments, which the beneficiary can easily do themselves.

They should not require the help of a certified Orthotist for the best possible fit.

The passage below explains the rules for the type of braces allowed –

Medicare Benefits Policy Manual Chapter 15 – Revised 2019 you can find it  here.

130 – Leg, Arm, Back, and Neck Braces, Trusses, and Artificial Legs, Arms, and Eyes (Rev. 1, 10-01-03) B3-2133, A3-3110.5, HO-228.5, AB-01-06 dated 1/18/01

“These appliances are covered under Part B when furnished incident to physicians’ services or on a physician’s order.

A brace includes rigid and semi-rigid devices which are used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. Elastic stockings, garter belts, and similar devices do not come within the scope of the definition of a brace.”

“Adjustments, repairs and replacements are covered even when the item had been in use before the user enrolled in Part B of the program so long as the device continues to be medically required.”

There are many elbow braces to choose from, and of course your Medicare-enrolled doctor will advise you on what type you need, and on the different brands.

Does Medicare cover back braces ?

Yes, Medicare Part B typically covers 80% of the cost of back braces, if you have a prescription from a Medicare-enrolled doctor certifying that you qualify under Medicare’s criteria, and the brace is “medically necessary”.

You will have to have a face-to-face meeting with the Medicare-enrolled doctor to get the prescription, so that they can actually see that you really need a brace, and if so, what type.

I have an article about Medicare and the coverage of back braces, with much more specific information about what qualifies for coverage, types of back braces and popular brands of braces which Medicare covers.

If you don’t qualify for Medicare coverage, I outline other sources of funding for a back brace for elderly adults. You can find that article here.
 

Medicare qualifying guidelines for back braces

As I said earlier, you will first need to obtain a signed prescription from a Medicare-enrolled doctor, stating that a back brace is “medically necessary”, to get coverage from Medicare Part B.

Here are the Medicare’s guidelines for when back braces are covered, which they are calling “Spinal Orthosis” –

“A spinal orthosis (L0450 – L0651) is covered when it is ordered for one of the following indications:

1. To reduce pain by restricting mobility of the trunk; or

2. To facilitate healing following an injury to the spine or related soft tissues; or

3. To facilitate healing following a surgical procedure on the spine or related soft tissue; or

4. To otherwise support weak spinal muscles and/or a deformed spine.

If a spinal orthosis is provided and the coverage criteria are not met, the item will be denied as not medically necessary.”

If you are to get coverage, the back brace has to be used to do one of the following  –

• to reduce pain by restricting movement of the torso
• promote with the healing of the spine or muscles, ligaments after an injury, or after surgery
• give support to a weak spinal muscle and/or a deformed spine

Medicare-approved back braces ?

Medicare Part B covers rigid, or semi-rigid braces of any type.

The two following exerts were taken from the Medicare Benefit Policy Manual, Chapter 15 –

“A brace includes rigid and semi-rigid devices which are used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body.”

The text goes on to say –

Once you have the prescription, the doctor will tell you will note the code of the  type of back brace you require on your prescription, and you will choose one of that type from different brands at the supplier.

Below are some of the more well-known brands –

• Aspen
• Corflex
• Comfortland
• Ossur

Your Medicare-enrolled supplier will have the brands he works with, so if you don’t find the brand you want, you may have to seek out a number of Medicare-enrolled suppliers. 

How often will Medicare pay for a back brace ?

Medicare Part B will replace covered DME  that are –

• worn out through use
• that have been in your possession for their entire lifetime
• so worn out that they can’t be fixed
• the minimum period considered to be a lifetime for DME is five years
• the lifetime can vary depending on the type of equipment

Typically, a back brace which is worn out can be replaced every five years, as long as it has been in the beneficiary’s possession for that whole period.

Medicare will pay to repair worn out items which don’t reach the end of their lifetime, but no more than the cost of a replacement.

When an item is replaced after 5 years, or when worn out, the claimant will go through the whole Medicare procedure again, starting with their Medicare-enrolled doctor.

Does Medicare cover knee braces ?

Typically, Medicare Part B will cover a knee braces, if you have had a face-to-face appointment with a Medicare-enrolled doctor, and were given a signed prescription stating that the brace was medically necessary.
 

Medicare knee brace qualifying guidelines

Medicare Part B gives covers knee braces under the Orthotics Benefit, and considers a knee brace to be “medically necessary” when –

• a person is able to walk
• a knee requires stabilization because of weakness or deformity
• you have had a recent injury to the knee
• you recently had a knee surgery, such as a knee joint replacement

Medicare-approved knee braces ?

Medicare approves four types of knee braces

Medicare coverage includes four types of knee orthotics.

Devices must help manage stability or give pain relief and allow the patient to carry out daily functions.

Functional – these braces are worn to give support to knees which have been injured in the past.

Functional braces may be used after surgeries to give support to the knee.

Rehabilitative or Postoperative – these braces, while allowing the joint to move, will protect ligaments and tendons after surgery by limiting potentially harmful movements during the rehabilitation.

Unloader or Off-loader – often to reduce pain from osteoarthritis.

Unloader braces take pressure off the sides of the knee by limiting the sideways movement, and by putting the pressure on the thigh.

Prophylactic – made for the prevention of knee ligament injuries, in particular the MCL ligament, these are frequently used by athletes and footballers.

Custom Fitted and Off-The-Shelf

Medicare Part B allows both Custom Fitted and Off-the-Shelf knee braces.

Custom Fitted braces –

Custom fitted braces can require a significant amount of alteration during the fitting to make them fit correctly, this has to be done by a certified Orthotist.

Off-The-Shelf braces –

These may be supplied as a kit, requiring only a minimal adjustment for to be fitted properly.

These should not require the help of a certified Orthotist for the best possible fit.

How much does Medicare pay for a knee brace ?

If you are enrolled in Medicare Part B, have had a knee brace prescribed as “medically necessary” by a Medicare-enrolled physician, purchased your back brace from a Medicare-approved “Participating” Supplier, Medicare covers 80% of the price of the back brace for you.

You will pay your 20% co-insurance, and also your deductible if it applies.

If you use a Medicare-approved supplier, but who is not a “Paticipating” supplier, you may have to pay up to 15% more.

If you do not use a Medicare-approved physician, or a Medicare approved supplier, or both, you will not be covered by Medicare.

Medicare-approved braces and devices

Medicare Part B, covers the following types of braces –

Back braces  –

• Lumbar Sacral Braces
• Thoracic Lumbar Sacral Braces

Shoulder braces

• shoulder immobilizers
• shoulder cradles
• shoulder stabilizers

Neck braces

• cervical collars
• some cervical traction collars

Foot and ankle braces –

• ankle-foot (AFO)
• knee-ankle-foot (KAFO)

Knee braces –

• rehabilitative
• functional
• unloader or off-loader
• prophylactic

Elbow braces –

• elbow immobilizer

Wrist braces –

• braces
• supports
• splints

Does Medicare cover “walking boots” ?

Medicare Part B does also typically cover “walking boots”, (or ankle/orthosis as they are known technically), if they have been prescribed by a Medicare-enrolled doctor certifying that they are “medically necessary”.

Medicare Part B, of course, will only cover the “walking boot” for certain conditions, which is why you will be obliged to have a face-to-face appointment with the prescribing doctor to establish that you qualify.

If you wish to know more about the conditions for qualification and the types of boot that Medicare will cover, you can read my article on Medicare and “walking boots”.

I also cover the different sources of funding which are available other than Medicare, such as Medicaid, Assistive Technology Projects and other state financial assistance funds which exist to help the elderly. You can read that article here.

Does Medicare cover bathroom equipment ?

Bathroom safety equipment for use in the home, in general, does not get coverage from Medicare Part B, for the simple reason that most of it is not considered medical in nature, and so cannot be “medically necessary”, and so can’t qualify for coverage.

Everything which is covered by Medicare must be “medically necessary”, which differs from state programs, which work to help the elderly maintain their independence in their homes, by creating a safe environment for them.

Medicare does cover the three following items which can be used in the bathroom to help with safety –

• crutches
• walkers
• bedside commodes

If you have a Medicare Advantage Plan, or Medicare Part C as it is also known, you may find that you will now be able to get bathroom safety equipment as a benefit.

Medicare Advantage Plans are having the number of benefits that they are permitted to offer expanded to make them more competitive, and these new benefits will be to help individuals with chronic conditions, and include amongst other things some bathroom safety equipment.

Don’t despair though, as I have written an article on bathroom equipment, Medicare, and the types of funding, grants and insurance, which will give coverage. If you are interested in that, you should take a look at my article here.

If you are starting out as a caregiver, and you want bathroom safety tips to help an elderly person with bathing, I have an article with over 50 tips that I have learned in my 10+ years as a caregiver.

It covers a whole range of safety issues, about setting up the bathroom, hazards to look out for, safety products, and a few tips on how to go about it. You can find that here.

What equipment does Medicare cover for use in the home ?

Medicare Part B will cover some durable medical equipment, or DME, for use in the home.

Durable medical equipment must –

• be able to withstand constant use over a sustained period of time – durable
• be medical in nature
• only useful to a person who is ill
• be principally for use in the home
• have a minimum lifetime of at least 3 years

How does a person get coverage from Medicare Part B for DME ?

To get coverage for durable medical equipment for “use in the home” –

• you need to be enrolled in Medicare Part B
• you need your Medicare-enrolled doctor to give you a signed prescription which states that the equipment is a “medically necessary”
• you need to purchase or to rent the equipment through a Medicare-enrolled supplier

Medicare defines  “living at home” as –

• living in your own home
• living in the family home
• living in the community, such as assisted living

Once you have a prescription, what is the procedure ?

It’s time to go choose your DME –

• go find some Medicare-enrolled DME suppliers in your area who have elbow braces
• make sure the supplier that you choose a Medicare-enrolled “participating supplier who accepts “assignment” – this way you don’t pay any extra
• select your elbow brace that you have been prescribed from the available choices
• if you don’t like the basic models of elbow brace which are covered by Medicare, you may have the opportunity on some models to upgrade to a better model, if you pay the difference yourself
• do all the paperwork for the elbow brace in compliance with Medicare for the supplier

Medicare part B covers 80% of the Medicare-approved price for the elbow brace if you used a Medicare-enrolled supplier with a signed prescription from a Medicare-enrolled doctor certifying that the brace is “medically necessary”.

If you used a Medicare-enrolled “participating” supplier who accepts “assignment”, you just have to pay your Medicare 20% co-payment of the Medicare-approved price for the elbow brace, and your deductible if it applies.

Do get your elbow brace through a Medicare-enrolled supplier who is a Medicare-enrolled “Participating” supplier who accepts “assignment”, if you don’t, you can end up paying extra for the brace.

Medicare will either rent or purchase DME – for the majority of equipment Medicare will rent from the supplier.

On rented items, you pay (monthly) a 20% co-payment of the Medicare-approved monthly rental price, and if it applies your deductible at the outset.

Finding a local Medicare-enrolled Supplier near you

You can use this link to find a Medicare-enrolled supplier who is local to you –  Medicare.gov

Does Medicare Advantage cover elbow braces ?

Medicare Advantage plans have to give the same coverage as Original Medicare Parts A and B – they are private providers who are contracted by Medicare to provide all the Medicare services with the same qualification rules as Medicare.

Whether the plans give more coverage than Medicare will depend on supplements they offer.

The Advantage plan will, though, use their own suppliers and doctors, and you will need to contact your plan provider about this.

If you go outside their network, you will doubtless lose coverage.

Durable Medical Equipment generally covered by Medicare if you qualify

If you don’t find the equipment you are looking for in my list of  Medicare covered DME below, you can use this link to Medicare.gov 

Air-Fluidized Bed
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
Bead Bed
Bed Side Rails
Bed Trapeze – covered if your loved one is confined to their bed and needs one to change position
Blood sugar monitors
Blood sugar (glucose) test strips
Canes (however, white canes for the blind aren’t covered)
Commode chairs
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Crutches
Cushion Lift Power Seat
Defibrillators
Diabetic Strips
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Heat Lamps
Hospital beds
Hydraulic Lift
Infusion pumps and supplies (when necessary to administer certain drugs)
IPPB Machines
Iron Lung
Lymphedema Pumps
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mattress
Medical Oxygen
Mobile Geriatric Chair
Motorized Wheelchairs
Muscle Stimulators
Nebulizers and some nebulizer medications (if reasonable and necessary)
Oxygen equipment and accessories
Patient lifts (a medical device used to lift you from a bed or wheelchair)
Oxygen Tents
Patient Lifts
Percussors
Postural Drainage Boards
Quad-Canes
Respirators
Rolling Chairs
Safety Roller
Seat Lift
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Sitz Bath
Steam Packs
Suction pumps
Traction equipment
Ultraviolet Cabinet
Urinals (autoclavable hospital type)
Vaporizers
Ventilators
Walkers
Whirlpool Bath Equipment – if your loved one is home bound and the pool is medically needed. If your loved one isn’t home bound, Medicare will cover the cost of treatments in a hospital.

Prosthetic and Orthotic Items

Orthopedic shoes only when they’re a necessary part of a leg brace
Arm, leg, back, and neck braces (orthotics), as long as you go to a supplier that’s enrolled in Medicare
Artificial limbs and eyes
Breast prostheses (including a surgical bra) after a mastectomy
Ostomy bags and certain related supplies
Urological supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.

Free help with understanding Medicare

SHIP – State Health Insurance Assistance Programs

For anyone needing help, there are free counseling services for Medicare, Medicaid and Medigap available from all State Health Insurance Assistance Programs – SHIPs.

Here’s how to find your local SHIP  – “Free Help Understanding Medicare And Medicaid ? Here’s Where You Get It”.

Does Medicaid cover elbow braces ?

Medicaid is funded both federally and by each individual state.

The individual states can have quite a lot of variety in the programs they provide with Medicaid, so long as they stick within the basic guidelines, and it is this which means that it offers, in many cases, far more than Medicare in terms of equipment for use in the home.

Medicaid will often allow a state to waive eligibility requirements for certain programs, so that a state may target a particular demographic with its health care.

The programs on which this is done are known as Waivers, and each different waiver can have its own set of peculiarities to help a certain group of people.

Care in the home – Medicaid and state programs

Programs which are principally for low income families, the disabled and the elderly, which work to provide health care services in the home and the community are called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”.

These programs have been designed to help the participants maintain their independence at home.

To facilitate this work, these HCBS programs, waivers and 1915 waivers will cover part, or all, of the cost of “home medical equipment” required by participants.

To find out if you are eligible for an HCBS program, or waiver, contact your State Medicaid Agency here.

Your local Area Agencies on Aging should also be able to help you find out about waivers in your state, and the eligibility criteria.

If you wish to learn more about HCBS programs or waivers in general, follow the link below –

https://www.medicaid.gov/medicaid/hcbs/authorities/index.html

Medicaid uses “home” to mean any of the following –

• their own home
• their family home
• a group home
• an assisted living facility
• a custodial care facility

Programs and waivers which will likely cover more varied DME for “in home use”

HCBS programs and waivers working with “Consumer Direction” or “Self Direction” 

These are management models for program budgets, where the participants, aided by a financial advisor, are largely in charge of the spending of their allocated resources.

The participant is given a budget with which to maintain their independence in their own home.

Items which are vital to the participant continued independence, as long as the budget covers it, are usually allowed.

The range of items to be considered as Durable Medical Equipment is considerably more flexible than that with Medicare.

Learn more about Medicaid Self Direction here.

Money Follows the Person

This is a federal Medicaid program which was designed to help elderly adults to leave nursing homes and to return to live independently in their own homes.

The Medicaid program will help states with the funding to set up their own Money Follows The Person programs – the individual states may use existing waivers already running, or they can establish entirely new programs.

A program’s participants will be assessed, and the necessary resources and materials will be provided, so that the transition from the nursing home to their own home can be made.

The programs may give money for a whole range of things – better lighting, safety equipment, security, medical equipment, or larger investments in remodeling bathrooms and kitchens where necessary.

How to find the HCBS programs, waivers and 1915 waivers in your state

Finding the Medicaid HCBS waivers and programs for seniors in your state is easy !

Just take a look at my guide listing them by state – the guide also includes all Money Follows The Person Programs and PACE Programs (Programs of All-inclusive Care for the Elderly).

You’ll find the guide here – “Medicaid Home and Community Based Services Waivers and Programs For Seniors Listed By State”.

How to get DME with Medicaid and state waivers and HCBS programs ?

Step 1

– the doctor, or therapist, has to provide a medical justification letter, stating it is medically necessary

Step 2

–  find a Medicaid-approved DME supplier, and give them the medical justification letter

Step 3

– the Medicaid-approved supplier fills out a Prior Approval Application form for Medicaid

Step 4

– the Prior Approval Application is sent to the Medicaid State Office

Step 5

– if you are unsuccessful you will be contacted and given the reasons as to why, as well as advice on how to make an appeal

Step 6

– if approved, you will receive the DME

If your income is a bit too high to qualify for Medicaid

Spend Down Programs

Medicaid’s Spend Down programs are designed to help more people to qualify for Medicaid coverage.

To do this, Spend Down programs employ several methods to try to lower a participant’s income level, or income + assets level, by deducting certain allowed medical and other expenses.

The goal is to lower the amount of assets and income a participant has, to a point where they are below the allowed limit for Medicare coverage.

The two methods are –

• Income Spend Down
• Asset Spend Down

You can find out about how it all works, and who is eligible, here – “What is Spend Down ?”

To find your State Medicaid State Agency

If you just want to talk to, or to email someone, contact your state Medicaid Agency here.

Step 1 –

Click the link to Medicaid.gov, look to the section I outlined in red.

Step 2 –

Select your state and click on the button they have marked “GO” – it will take you to your State Medicaid Agency with all their contact info.

How to get free elbow braces

There are a number of resources which you can use in your state to find out if you can get free elbow braces.

Looking for free items of equipment like a crutch, or a cane, is may be somewhat less risky than an elbow brace, as your elbow may require a very specific brace, which has to be diagnosed and fitted by a treating medical practitioner.

That said, the funding sources will pay for a new elbow brace etc., but used braces which have been refurbished will need to be properly fitted.

You may find funding for, or free refurbished, elbow braces –

Assistive Technology Programs

Every state receives an Assistive Technology Program grant to improve access to assistive devices in the home – they are principally focused on the elderly and the disabled.

“Assistive Technology” is equipment which assists users in completing tasks they have trouble with. The equipment can be anything from a special dressing aid to digital communication devices.

To find out what projects your state runs, click here

Step 1/

Pick your state on the map or the drop-down menu, and click on “Go to state”

– I chose Florida for this example

Step 2/

Click on the link “Program Title” – for my example I outlined it in red.

Step 3/

The AT Program state website will come up, and you can sign up, or use their contact info .

State Financial Assistance Programs

State Financial Assistance Programs are found in some, but not all, states.

These are non-Medicaid programs focused on helping the elderly to remain living in their homes.

Equipment which is needed for the elderly to participate in the programs, and even remodeling bathrooms, kitchens, or building wheelchair ramps are paid for with grants or loans, or a combination of both.

I would suggest you go ask about these programs at your local Area Agency on Aging.

Free elbow braces near me ?

Here’s how to find free medical equipment near to where you live.

Free elbow brace on online listings and groups

Online listings are a good place to look for free medical equipment.

With these online listings and groups, you can make the searches as local as you want.

Important points to remember –

• There is no guarantee of the quality of the equipment you are going to find, and if it is faulty you won’t have any recourse, you will be accepting it for free in the condition that you find it
• Pick up equipment with a friend – you never know who you are meeting.
• Do not have the items brought to your home  – meet up somewhere local, away from your home

Here are the online listings and groups where you can find used medical equipment –

• Craigslist online listing
• UsedHME.com
• Freecycle.org
• Nextdoor.com
• Facebook Groups and Facebook Marketplace
• Buynothingproject.org

Free elbow braces from Medical Equipment loan closets

Medical equipment loan closets are also called –

• medical equipment lending libraries
• community loan closets
• assistive technology lending libraries
• lending libraries
• medical equipment banks

You can contact your town council human services, or senior services department, or any public senior center near you to ask if they know of any.

The loan closets offer free (usually), gently used, equipment on loan, either temporary or long term.

You can find many loan closets run by American Legion and Lions Clubs, for their local communities, and a few by Elk lodges.

Where to ask about free elbow braces in your neighborhood

If you have had no luck with the options so far, you want  to contact one, or more, of the following groups in your neighborhood to ask if they know of any group who can help with your search –

• Your local Area Agency on Aging
• Lions Clubs
• Rotary Clubs
• Local church communities

Summary

If you have a signed prescription from a Medicare-enrolled doctor certifying that an elbow brace is “medically necessary”, you can typically get rigid and semi-rigid elbow braces covered 80% by Medicare Part B.

You should always get your elbow brace through a Medicare-enrolled “Participating” supplier who accepts “assignment”, so that you only have to pay a co-payment of 20% of the Medicare-approved price, and your deductible should it apply.

If by any chance you don’t qualify for Medicare coverage, take a look at Medicaid, HCBS programs, waivers, 1915 waivers and State Financial Assistance Programs for which you may be eligible.