Are Prosthetic Legs Covered by Insurance?

According to the Amputee Coalition, almost 2 million Americans are living without a limb. The medical costs associated with amputation is more than $8 million. And that doesn’t even include the expense of prosthetics. 

Prosthetic limbs, especially legs, can be significant investments for anyone. But for people who need them, they’re usually a necessity for their quality of life. In most cases, medical insurance does cover at least part of the expense of prosthetic legs. And almost all of them will cover the costs related to their use. For example, wearing prosthetic legs requires the use of things like Silipos socks and pads for comfort. These are items typically covered by insurance policies up to the deductible. However, every company and policy is different, so it’s important that you talk to your agent about your specific coverage. 

Types of prosthetic legs

Often, the amount of coverage provided by insurance for prosthetic legs depends on the type of device it is. Some insurance companies will pay only a certain amount, which covers just the basic prosthetic device. But many types of prosthetic legs are available, and some people prefer to use something more aesthetically appealing or functional for their lifestyles.

The basic types of prosthetic legs are “below the knee,” or BK, also called a transtibial; and “above the knee,” or AK, also known as transfemoral. But the construction of these prosthetics is what makes them different. For example, prosthetic running blades are popular among athletes. They are usually made with a strong but flexible metal design that allows for movement with less weight. 

Some people prefer prosthetics that look more natural. Basic prosthetic legs are made of flesh-colored plastic and metal. It’s typical to see one with a plastic socket and foot and a metal “leg.” The feet on these are usually shaped like the human foot, but don’t have much detail. So, some people prefer the entire prosthetic to be covered in plastic so that it better resembles a human leg. And they prefer more details on the foot. 

Other financial resources

The cost of prosthetic limbs can range from $5,000 to well over $50,000, depending on how the device is built. And the most expensive ones are the above the knee prosthetic legs. But what makes them even more expensive is that they only last three to five years. Unfortunately, most private insurance companies cap their prosthesis coverage at around $5,000. And some are even lower, at around $2,500. 

Because of these high costs and low caps, most people need alternative methods of financial assistance paying for their prosthetics. If you’re over 65, you probably qualify for Medicare, which can help supplement the cost of things like prosthetic limbs. If you’re not over 65, you might qualify for Medicaid instead. Of course, these plans have a lot of stipulations, but as someone with a disability, you’ll likely be able to receive coverage.  

Aside from government resources, though, you may have other options. First of all, if your amputation was caused by an injury, you may be entitled to a personal settlement from a third party. It’s important to contact your personal injury lawyer immediately under these circumstances. 

Many charitable organizations also help cover these costs for certain individuals. So, if this is something you need help with, speak to your doctor or the company designing your prosthetic leg about other resources. If you’re a veteran, however, the best place to start with is your local Veterans Affairs hospital. There, they can connect you with resources specific to military personnel injured in the line of duty.