Insurance and prostheses.
Financing plays a big role in determining your component options. Fortunately, there are many paths to an affordable combination that’s right for you. Keep reading to learn about typical pricing tiers, payment options, and factors that can impact coverage, as well as how the payment process often works — and how you can make all the difference.
Financing plays a big role in determining your component options. Fortunately, there are many paths to an affordable combination that’s right for you. Keep reading to learn about typical pricing tiers, payment options, and factors that can impact coverage, as well as how the payment process often works — and how you can make all the difference.
There are three common coverage levels for prostheses.
While the cost of prosthetic components may vary for many reasons, most devices fall into one of three pricing categories: Premium (highest cost), standard (mid-level cost), or value (lower cost). Which tier a prosthesis falls into depends on many factors, such as its features, capabilities, materials and more.
Premium prostheses
These top-of-the-line solutions provide advanced features and mimic the natural limb as closely as possible. Often covered only for the most highly active and capable users, premium prostheses may offer more customization, durability, digital features and other benefits compared to standard and value tiers.
Four considerations that can impact your financial coverage.
Many factors can have an impact on your ability to get financial coverage for your preferred prosthesis. These four often have the biggest influence.
Insurance plan details
If you have private, government-funded or other health coverage, the details of your plan will often determine what prostheses may be paid for in full, in part, or not at all.
These details can include your overall coverage level, deductible, co-insurance, geographic or provider-based network restrictions, and prior authorization requirements.
Be sure to review your plan details carefully and discuss your options with a knowledgeable prosthetist who can help you understand and navigate your coverage.
Know your payment options.
There are many ways to secure payment for your prosthesis, although these vary depending on your location and other circumstances. Keep reading to learn more about what payment options may be available to you.
Public payers.
Depending on where you live, your age, your health and other factors, you may have government, state, or other public payment options available to you.
Whether it’s a single-payer system, such as in Canada, or a multi-payer system, such as in Germany, many countries provide universal healthcare that may cover some or all of your preferred prosthesis. In the United States, senior citizens, people with certain health conditions, or those who have limited income also receive partial coverage from state and/or federal government programs.
There are also foundations and other regional resources open to the public that you may be able to tap into.
Private insurance.
In many healthcare systems, you may have private insurance instead of or in addition to government-funded healthcare.
Different insurance plans will cover various aspects of your prosthetic journey depending on your plan details. Typically at least part, if not all, of your initial evaluations, fitting, the prosthetic device itself, maintenance, and replacements will be covered.
You may also be able to get gap insurance to help pay for out-of-pocket expenses — such as copays, co-insurance, deductibles, and advanced features — that are not covered by your primary insurance plan.
Self-pay.
In some healthcare systems, most prostheses may only be available for cash. If you live in an area with one of these systems, you may be able to pay for part or all of your prosthesis yourself, either directly, through a special healthcare savings account, or via fundraising.
Combination coverage.
Often, prosthesis users wind up taking advantage of a combination of these methods in order to secure the products they want.
For example, you may live in a country where part of your solution is covered by a government healthcare system. You may also have gap insurance to cover even more of the same device. Then you may be able to raise funds to cover the remaining cost.
In the end, there’s no wrong way to go about paying for your preferred prosthetic components, and your commitment to getting the combination you want goes a long way in determining your success.
A step-by-step guide to paying for your prosthesis.
The process of paying for your prosthesis varies widely depending on where you live, what types of payment options are available to you, and what type of components you’re trying to purchase. Here’s a high-level explanation of what you can expect.
Get a recommendation
First, a physician will refer you to a prosthetist who will perform a thorough evaluation of your residual limb, lifestyle needs, and mobility goals. This is also a great opportunity to discuss prosthetic components or combinations you’re interested in.
After this evaluation, your prosthetist will recommend a set of components that best fits your circumstances and preferences, and start the discussion about which options are most financially feasible for you.
Your payment questions, answered.
Below, you’ll find answers to some of the most common questions that prosthesis users have about the insurance and payment process.
Other organizations you can turn to for financial support.
If you need help finding more financial assistance options, there are many advocacy and support groups for people with limb loss who can help. Many of these groups can help connect you with funding opportunities, fundraising support, or other ways to pursue the coverage you need to secure the best possible prosthesis.
Here are some sample organizations to consider contacting:
Amputee coalition: An organization dedicated to empowering the limb loss and limb difference community in the US since 1986.
ic2a: The International Confederation of Amputee Associations is dedicated to inspiring improvement in the quality of life of amputees and individuals born with limb deficiency.
We’re here to help you find the best possible options.
Submit the form below if you’d like to learn more about recommended prosthesis combinations, have questions about reimbursement, or would like to connect with a prosthetics professional who can evaluate your specific situation.