Will Medicaid Cover Prosthetics?
This information is current as of June 24, 2022.
Losing a limb is a life injury that affects mobility and financial stability. If you or someone you know is currently on Medicaid and requires a prosthetic, it’s understandable that you’re concerned about whether the federal aid program will cover their care. Although every state has different coverage, we can guarantee you’ll receive some support.
Medicaid may be a federal support program, but every state sets its requirements and coverage. Fortunately, every state in America offers support for patients requiring prostheses. Please visit their dedicated Medicaid website to learn more about your state’s eligibility.
Don’t let a prosthetic ruin your life or finances. Just because you or your family earns less than the national average doesn’t mean you should live in pain. Continue reading to learn more about Medicaid and how the federal government provides for patients who have lost a limb.
What Does the Federal Government Say About Prosthetics?
The Centers for Medicare & Medicaid Services sets Medicaid foundational terms as a federal aid program.
Policies are set at the federal level and provide a basis for every state. It’s then up to the individual state executive branches to determine which services are covered.
When checking the Centers for Medicare & Medicaid Services’ policies, you’ll be disappointed to learn that the federal government does not require states to provide funding for prosthetics. The range of federally mandated services is relatively limited and designed to cover basic inpatient and outpatient care.
So … Will Medicaid Cover Prosthetics?
Fortunately, although the federal government hasn’t mandated financial support for patients with prosthetics, every state in the United States offers some care for prosthetics and orthotics. An overwhelming majority of states even cover the cost of copayments for prosthetics.
For more information, we recommend checking out your state’s Medicaid site or browsing the website at this link.
Does Medicaid Cover Visual Prosthetics?
In addition to supporting patients who have lost a limb, Medicaid also covers the cost of visual prosthetics for those who have lost their sight.
Medicaid’s coverage for visual prosthetics is relatively new. Currently, every state does offer coverage for ocular implants though the technology continues to advance.
For example, the bionic eye, or retinal implant, is one of the most common visual prosthetics that Medicaid covers. This device is surgically implanted into the eye and helps to send electrical signals from the eye to the brain. As a result, patients can see basic shapes and objects.
If you need a visual prosthetic, we recommend speaking with your doctor ahead of time to learn more about your coverage. Your doctor should be able to provide more information about which Medicaid covers implants and services, or you can contact your local Medicaid representative.
Does Medicaid Cover Auditory Prosthetics?
When it comes to auditory prosthetics, things start to get iffy. Compared to a prosthetic limb or ocular implant, Medicaid doesn’t always consider auditory prosthetics necessary.
Depending on your state, you may qualify for coverage. Currently, the following states do not offer Medicaid support for auditory prosthetics:
Arizona – Arizonan Medicaid does not offer coverage for cochlear implants, bone-anchored hearing aids, or standard hearing aids.
Pennsylvania – Pennsylvanian Medicaid will not cover standard hearing aids.
Several other states set limits based on prior authorization and availability of the implants. We recommend contacting your local Medicaid office or researching your state’s dedicated Medicaid website to learn more.
Does Medicaid Cover the Cost of Running Blades?
Running blades are a type of prosthetic device used by people who have had their legs amputated. The blades provide the user with a more natural running motion and are made from various materials, including carbon fiber and titanium.
However, compared to standard prosthetic legs, they are not considered medically necessary, and Medicaid will not cover the cost of a running blade prosthetic. You can still try to find financial support to purchase a running blade if you wish to continue exercising after losing a limb.
Amputee Blade Runners is a non-profit organization out of Tennessee that helps amputees stay in shape by providing free running blades to anyone in need. They receive funding from donors and use that money to purchase blades and train children to run using their prosthetics.
To qualify for running blades, the organization asks that applicants:
- Complete three 5K races and submit their results
- Pass the 1-year mark since their first prosthetic fitting
- Live in the United States
The organization will review your application and approve you for a fitting if you qualify.
Will Medicaid Cover the Cost of a Wheelchair?
If you’re an amputee, you may wonder whether Medicaid will also cover the cost of a wheelchair. Although all states do consider wheelchairs to be medically necessary, the way you receive funding may differ from state to state. For example, if you currently live in a state with Medicaid-funded nursing homes, you can receive a free chair from home but not independently.
Additionally, not all states provide funding for all motorized wheelchairs. Depending on where you live, you may have to meet specific qualifications before being eligible for a motorized option. Check with your state’s Medicaid support service to learn more and inquire about securing a wheelchair as an amputee.
What Other Disability Services Can I Claim Through Medicaid as an Amputee?
Losing a limb is a trying experience, but you don’t have to go through it alone. In addition to receiving support for prosthetics, there are various other services that you may be eligible for as an amputee. We’ve compiled a list of the most common services below:
- Mobility devices and support – If you’re an amputee, you may struggle with your mobility. Several states offer support for patients requiring canes, walkers, and other devices to help their mobility.
- Physical therapy – Many states (but not all) offer support for physical therapy as it can help amputees regain their strength and improve their mobility.
- Occupational therapy – Like physical therapy, occupational therapy can help patients regain their strength and improve their mobility. However, occupational therapy also focuses on assisting patients in relearning how to perform everyday tasks, such as cooking and cleaning.
- Emotional support – The loss of a limb can be emotionally taxing. As a result, some states also offer counseling and support groups for amputees.
If you’re an amputee, we highly recommend taking advantage of your services. Losing a limb is a severe injury. It would be best if you didn’t have to go through it alone.
Additional Financial Support for Amputees
You may also qualify for federal support beyond Medicaid if you have lost a limb. The federal government considers the loss of a limb a severally debilitating injury that can affect your ability to work. Depending on your situation, you may qualify for the following financial support:
- Social Security Disability Insurance – If you have worked in the past and contributed to the Social Security system, you may be eligible for social security disability insurance. To qualify, you must have lost your limb within the past seven years and be unable to work due to disability.
- Supplemental Security Income – If you have never worked or contributed to the Social Security system, you may still be eligible for supplemental security income. To qualify, you must have a limited income and assets and be unable to work due to your disability.
- Veteran’s Benefits – If you’re a veteran who has lost a limb, you may be eligible for veteran’s benefits. These benefits can help you cover the cost of prosthetics, therapy, and other needs.
Please visit the Social Security Administration’s website for more information about the social security disability program. Each program has eligibility requirements.
Although the federal government does not require states to provide financial support for prosthetics, every state in America offers some level of care. Therefore, Medicaid coverage for prosthetics may vary from state to state, but you can be sure you’ll receive some support.
In addition to prosthetics, Medicaid covers the cost of other disability services, such as physical therapy, counseling, and mobility devices. So if you’re an amputee, we highly recommend taking advantage of your services.
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