Public Insurance Options: Medicare and Medicaid
For those with Medicare, both the doctor and artificial limb supplier must be enrolled in the program, which uses the K-level to determine the type of prosthetic that will be covered. This system is how the Centers for Medicare & Medicaid Services (CMS) deems a prosthetic device medically necessary.
You must first meet your Part B deductible, but after Medicare deems a prosthesis medically necessary, you will be responsible for only 20% of the Medicare-approved prosthetic amount, and Medicare will cover the rest.
As for Medicaid, coverage is provided for specific devices, and the extent of coverage can vary from state to state. If you have Medicaid, you will want to check your local laws to see if Medicaid coverage is available for your desired prosthetic type.
Coverage for Medicaid is based on medical necessity, like Medicare, but there are also limits on the type of the prosthetic covered. Your prosthetic team can help you work with your Medicaid coverage to find the best prosthetic for you.