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Does Medicare Cover Back Braces?

According to the data, 80% of Americans will experience back pain some time in their life. And we spend over $50 billion a year treating back pain!

One common treatment option is the use of a back brace. If you’re over 65 and experiencing back pain, one common question you probably have is “does Medicare cover back braces?”

In this article we answer the question in clear, plain English. You’ll also find the average costs of back braces as well as other helpful info.

Does Medicare Cover Back Braces?

Yes, Medicare will often cover back braces. But not all the time. As is often the case with Medicare, you have to meet certain requirements in order to get Medicare to pay for your back brace. Let’s dig a little deeper and see what those requirements are.

Your doctor may recommend a back brace if you’re suffering from various conditions that cause lower back pain. In order for Medicare to cover the cost of a back brace, your doctor has to consider the back brace as medically necessary to treat or manage your condition. And s/he will have to give you a specific prescription stating why you need the back brace.

In this case, Medicare Part B will cover 80% of the costs of your back brace. This is because back braces are considered to be prefabricated orthotics by Medicare. Prefabricated orthotics fall under durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

Now suppose you live in an area where there is an off-the-shelf back brace included in the DMEPOS Competitive Bidding Program. In this case, Medicare may cover for them but only if you buy the back brace from suppliers contracted with Medicare.

Contract suppliers must provide the item to you and accept the assignment as part of their Medicare contract. Medicare will cover the back brace if the supplier is enrolled in Medicare and accepts the assignment.

Now what if the supplier is enrolled in Medicare but is not a participating supplier? In this case, he/she can choose not to accept the assignment. So be sure to do your homework and only buy your back brace from a participating supplier if you want Medicare to cover it.

Also, some Medicare Advantage plans, like HMO or PPO, cover back braces and even have additional coverage.

How Much Does A Back Brace Cost?

Without insurance, a back brace may cost between $40-$1000 depending on the type, material, size, and whether it is off-the-shelf or custom-made.

There may be additional fees if you need physical therapy as well. Uninsured patients may pay $50-$350 per session, while insured patients may have coverage that decreases the costs to $10-$75.

Another additional fee may be added with X-rays to look at the progress.

About Back Braces

As people get old and past their prime ages or physical peak, the body may start to deteriorate and weaken, no matter how healthy their lifestyles can be. Older people become more prone to injuries and chronic conditions.

A doctor recommended a back brace for people who are having back issues and pain. Back braces are a safe and non-invasive way to support your back and immobilize the spine.

Back braces can improve the state of your back. Of course, this is with proper guidance from your doctor regarding the proper type and how long you should wear them. You can also ask your doctor for exercises you can perform while wearing back braces.

Types of Back Braces

There are two varieties of back braces, the soft and the rigid types.

Soft braces are made with soft and breathable fabric and with adjustable elastic or Velcro closures. This type of braces compresses the abdominal region and supports that hold up the skeletal structure, resulting in relief from pressure on the spine.

There are soft braces that are designed to support the wearer while he/she is carrying heavy objects. Others give lightweight support throughout the day.

On the other hand, rigid braces are made to support the wearer following an injury or surgery. The lower back portion is usually made with plastic parts and is attached with Velcro straps.

Most scoliosis braces are rigid to prevent the spine from further curving. Some rigid braces types include:

  • Boston brace provides support from the shoulder to the tailbone in the back. It also provides support from the chest to the pelvis in front. These braces are worn all the time except when bathing or swimming.
  • Milwaukee brace is similar to the Boston brace in design but has an additional piece that braces the neck. It has to be worn all the time as well.
  • Charleston brace is designed for scoliosis patients and must be worn when they are sleeping. The asymmetrical shape exerts a force that corrects the spine and helps it grow straight.

Benefits of Wearing a Back Brace

Benefits of wearing back braces may include:

  • Assisting the user as he/she recovers from an injury
  • Reduce the risk of suffering injuries
  • Removes discomfort brought by pain
  • Support weakened muscles
  • Improves posture
  • Immobilizes the spine
  • Prevents or corrects deformity in the back

Note: Medicare coverage changes all the time. And your specific coverage may impact what gets covered and what doesn’t. Always be sure to double check with your health care provider and/or Medicare insurance provider about what is and isn’t covered by your plan.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover knee braces?

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