Anthem Blue Cross Coverage for Knee Braces
Yes, Anthem Blue Cross covers knee braces and orthotics as durable medical equipment (DME) when medically necessary. Coverage is available on both commercial and Medicare Advantage plans. A physician prescription is required, and custom orthotics may need prior authorization.
Quick Facts
| Coverage Aspect | Details |
|---|---|
| Covered? | Yes (as DME) |
| Prescription Required | Yes |
| Prior Authorization | For custom braces |
| Network | In-network DME supplier recommended |
Types of Braces Covered
| Brace Type | Typically Covered | Notes |
|---|---|---|
| Basic knee sleeve | Yes | Physician prescription needed |
| Hinged knee brace | Yes | Common for OA and instability |
| Unloader/offloader brace | Yes | May need prior auth |
| Custom-molded brace | Yes | Prior auth usually required |
| Post-surgical brace | Yes | Part of surgical coverage |
How to Get a Covered Brace
- See your doctor about your knee condition
- Get a prescription that specifies the type of brace and diagnosis
- Find an in-network DME supplier through Anthem’s provider directory
- Request prior authorization if getting a custom brace
- Receive your brace and pay your cost-share
Important: Using an out-of-network DME supplier can dramatically increase your out-of-pocket costs. Always check Anthem’s provider directory at anthem.com or call member services to find an in-network supplier.
What You’ll Pay
| Plan Type | Typical Cost |
|---|---|
| PPO in-network | 20% coinsurance after deductible |
| HMO | 20% coinsurance |
| High-deductible | Full cost until deductible met |
| Medicare Advantage | 20% coinsurance |
| Out-of-network | 40-50% coinsurance |
DME costs vary widely. A basic knee sleeve may cost $30-$80, while a custom unloader brace can cost $800-$2,000 before insurance. Your out-of-pocket amount depends on your plan’s DME benefit.
Custom vs. Standard Braces
Standard braces are pre-made and come in common sizes. They cost less and are available quickly. Good for mild to moderate support needs.
Custom braces are made specifically for your leg. They require fitting and take longer to receive. They cost more but offer superior support for severe OA, ligament injuries, or post-surgical recovery. Anthem typically requires prior authorization for custom braces.
Tips for Getting Coverage
- Always get a prescription from your physician first
- Use an in-network DME supplier to reduce costs
- Get prior auth for custom braces before the supplier orders them
- Keep receipts and documentation in case of billing questions
- Ask about replacement policies if your brace wears out
Tip: Log in to anthem.com to search for in-network DME suppliers in your area. You can also call the member services number on your card to ask about your DME benefit details.
Related Resources
- Anthem Blue Cross Coverage Overview
- Knee Bracing and Orthotics Guide
- Anthem Physical Therapy Coverage
This guide provides general information about Anthem Blue Cross DME coverage. Your specific benefits depend on your plan type, state, and employer. Always verify coverage with Anthem member services before ordering any brace or orthotic device.