Is prosthetics & orthotics covered by insurance?
Artificial limbs, braces, and prosthetic devices. Here’s how each kind of plan usually handles it.
- Employer or MarketplaceCovered with conditions
Usually covered when medically necessary.
More details
Plans cover artificial limbs and braces with approval first. Many states require plans to cover them as well as other medical care.
Cost: DME or prosthetic cost sharing.
- Original MedicareCovered with conditions
Yes, Part B covers prosthetic devices and limbs.
More details
Includes artificial limbs, eyes, and breast prostheses after mastectomy.
Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.
- Medicare AdvantageCovered with conditions
Yes, Medicare Advantage plans must cover prosthetics & orthotics, but your plan sets the copay.
More details
Includes artificial limbs, eyes, and breast prostheses after mastectomy. plans must cover this too, but set their own copays and often require providers and prior authorization.
Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
- MedicaidCovered with conditions
Covered with authorization; limits vary by state.
More details
Children are covered under .
What usually has to be true
- You need a prescription and paperwork from your doctor.
Good to know
- Replacement is covered when medically necessary or due to changes in your condition.
- Medicare Part B covers one pair of therapeutic shoes and inserts a year for people with diabetes who qualify.
Related
- Wheelchair or scooter · Manual and power wheelchairs and scooters.
- Physical therapy · Outpatient PT for injuries, surgery recovery, and pain.
Sources
Typical rules for 2026 plans, checked against these sources on October 20, 2026. Your plan’s own documents decide.
- 1What Marketplace plans cover
HealthCare.gov
Marketplace plans cover outpatient care, hospitalization, mental health care, prescription drugs, rehabilitation, laboratory services, preventive services, and other essential benefit categories.
- 2Prosthetic devices
Medicare.gov
Part B covers prosthetic devices that replace an internal body part or function, plus artificial limbs and eyes; you pay 20% after the deductible.
- 3Compare Original Medicare and Medicare Advantage
Medicare.gov
Medicare Advantage plans cover everything Original Medicare covers (except hospice, which Original Medicare continues to pay), usually use provider networks, often require referrals or prior authorization, and may offer extra benefits such as dental, vision, and hearing.
- 4Mandatory and optional Medicaid benefits
Medicaid.gov
States must cover mandatory benefits such as inpatient and outpatient hospital care, physician services, laboratory and X-ray services, home health, and nursing facility care; many other benefits, including adult dental, vision, and prescription drugs coverage details, are state options.
General information about how coverage usually works, not a decision about your plan. Your plan documents and insurer have the final word.