Call to speak to a Licensed Insurance Agent
Fully 33% of Americans will experience knee pain at some point in their lives.
And, unfortunately, the number of people affected by knee pain is on the rise. In fact, it’s up by almost 66% in the past 2 decades.
Knee pain is much more common in older adults. And braces are a common treatment. So a common question many have about knee pain is “does Medicare cover knee braces?”
We answer that question below is clear, plain English. Also, you’ll find what the average costs of knee braces are along with other helpful information.
Does Medicare Cover Knee Braces?
The short answer is, yes, Medicare will cover the cost of knee braces. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your knee brace.
Generally, Medicare Part B covers Durable Medical Equipment (DME). And Medicare considers knee braces to be DME because they fall under the criteria of what a DME should be.
However, Medicare will only cover knee braces if your doctor says it is medically necessary. And it will require your doctor’s order along with a statement saying why you need the brace.
For Medicare to cover a knee brace, it should generally be a rigid or semi-rigid brace. And it must be used to support the damaged or deformed body part or prevent the damaged part from moving.
Suppose you reside or visit a competitive bidding area, included in the DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, & Supplies) Competitive Bidding Program. In that case, Medicare may cover them, but only if you use contract suppliers.
Contract suppliers are obligated to provide you the knee braces. They must accept the assignment as it is part of their contract with Medicare.
Also, your doctor may refer you to an orthopedist. Orthopedists are health professionals who build and fit knee braces, as well as other braces.
Once all requirements are met, Medicare will cover 80% of the knee brace’s cost.
How Much Does a Knee Brace Cost?
Basic knee braces made out of elastic or fabric usually cost $10-$50 if you are not insured. Basic knee braces are used for light to moderate support during sports.
Knee braces used for recovery from injuries and surgery can cost from $30-$800, depending on the materials made to build the brace. Braces made of neoprene cost below $150, while lightweight aluminum or other durable material braces can cost $200 or more.
Braces used for arthritis cost between $50-$900. The cost depends on the materials used;
Wraparound fabric or neoprene braces cost below $100 while metallic braces can cost $400-$900.
Why Is Knee Pain So Common?
As we get older, our bodies become more fragile, and our systems slow down and become more and more vulnerable. And this is especially true for those living an unhealthy lifestyle. Because of this, our bodies become more prone to diseases, illnesses, conditions, and injuries – both permanent and not.
Osteoarthritis is a common form of arthritis that affects millions of people around the world. It happens when the protective cartilage that cushions the edge of our bones wears down over time. This explains why it occurs more to older people. This osteoarthritis is a common cause of knee pain in older adults.
Types Of Knee Braces
Standard knee braces are worn by those who suffered a knee injury or those who want to prevent one. They are usually worn when performing high-intensity exercises that stress the knees. Despite being uncomfortable, they provide support and stability.
Functional knee braces are worn by people who have already suffered a knee injury before. This type of brace helps the user to perform activities that are impossible without it.
Unloader knee braces, also known as offloader knee braces, are used to treat pain and inflammation. It is commonly used by those who have arthritis and can also be used for other conditions such as osteoporosis. Unloader knee brace provides stability, support, and pain relief at the same time.
Football athletes use prophylactic knee braces for knee protection. They are often made with bars or hinges, straps, and adhesives to fit the legs. Prophylactic knee braces absorb impact when working out, playing, or running. It keeps the knee stable by decreasing the force placed on the knee.
Rehabilitative knee braces are often used by people who suffered an injury or are recovering from surgery. This limits the movement of the knee, allowing it to heal.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
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 corneal cross-linking?