Medicare Coverage for Knee Braces
Yes, Medicare Part B covers knee braces as Durable Medical Equipment (DME) when medically necessary and prescribed by a physician.
Quick Facts
| Coverage Aspect | Details |
|---|---|
| Covered? | Yes, under Part B (DME benefit) |
| Prior Authorization | Not usually (may be required for custom) |
| Your Cost | 20% coinsurance after deductible |
| Typical Out-of-Pocket | $20-$200 depending on brace type |
| Must Use | Medicare-enrolled DME supplier |
Types of Braces Covered
Basic Knee Supports
Simple elastic or neoprene sleeves:
- Cost: $20-$50 retail
- Medicare pays: 80% of approved amount
- Your cost: ~$5-$15
Hinged Knee Braces
More supportive braces with hinges:
- Cost: $100-$300 retail
- Medicare pays: 80% of approved amount
- Your cost: ~$25-$75
Custom Knee Braces
Custom-fitted orthoses for specific conditions:
- Cost: $500-$1,500+
- Medicare pays: 80% of approved amount
- Your cost: ~$100-$300+
- May require prior authorization
Unloader Braces
Specialized braces for knee OA that shift weight off damaged compartment:
- Cost: $400-$1,200
- Medicare pays: 80% of approved amount
- Your cost: ~$80-$250
- Requires documentation of OA location
Requirements for Coverage
1. Physician Prescription
Medicare requires a written order from your doctor including:
- Your diagnosis
- Medical necessity statement
- Type of brace prescribed
- Duration of need
2. Medical Necessity
Your records should document:
- Knee instability or pain
- Functional limitation
- How the brace will help
- Failed or concurrent conservative treatment
3. Medicare-Enrolled Supplier
Critical: You must obtain your brace from a Medicare-enrolled DME supplier. If you buy from a non-enrolled source, Medicare will NOT pay.
To find enrolled suppliers:
- Call 1-800-MEDICARE
- Visit Medicare.gov supplier directory
- Ask your doctor for recommendations
What You’ll Pay
| Brace Type | Typical Approved | Medicare Pays | You Pay |
|---|---|---|---|
| Basic sleeve | $30 | $24 | $6 |
| Hinged brace | $150 | $120 | $30 |
| Unloader brace | $700 | $560 | $140 |
| Custom brace | $1,000 | $800 | $200 |
After meeting $240 annual deductible
How to Get a Brace Through Medicare
Step 1: See Your Doctor
- Discuss knee symptoms and instability
- Get examination and documentation
- Request prescription for appropriate brace
Step 2: Get a Prescription
Ensure it includes:
- Diagnosis (ICD-10 code)
- Type of brace needed
- Medical necessity statement
- Estimated duration of need
Step 3: Find Medicare-Enrolled Supplier
- Ask doctor for recommendations
- Verify enrollment on Medicare.gov
- Get cost estimate before ordering
Step 4: Obtain Your Brace
- Supplier will bill Medicare directly
- You pay your 20% coinsurance
- Keep receipts and documentation
Bracing as Part of Treatment
Knee braces can complement other treatments:
| Combined With | Benefit |
|---|---|
| Physical therapy | Stability during exercises |
| HA injections | Support while medication works |
| Weight loss | Joint protection during activity |
| Activity modification | Allows continued function |
Common Issues to Avoid
Buying Before Prescription
Don’t buy a brace and expect reimbursement later. Medicare requires:
- Prescription FIRST
- Then obtain from enrolled supplier
- Supplier bills Medicare directly
Non-Enrolled Suppliers
Retail stores, Amazon, and many online sellers are NOT Medicare-enrolled. Verify before purchasing.
Over-the-Counter Braces
Simple OTC braces from pharmacies generally aren’t covered. Medicare covers braces when:
- Prescribed by physician
- Medical necessity documented
- Supplied by enrolled provider
Medicare Advantage and Braces
If you have Medicare Advantage:
- DME coverage follows Original Medicare rules
- Network restrictions may apply
- Some plans offer expanded coverage
- Check your specific plan benefits