What are somatic prostheses?
People who have lost a hand, finger or toe often utilize somatic prostheses – pieces of durable medical equipment – to return to normal function and complete everyday activities. Prosthetic hands, fingers and toes restore the ability to grasp. They resemble the actual body part, normalizing the user's appearance, and are generally made of silicone that mimics the appearance and texture of skin. Prosthesis are typically designed specially to fit the user's body, and they may be painted to match the person's skin color. They're generally held in place using medical-grade adhesive or natural suction. They generally last several years but require regular cleaning and maintenance.
Does Medicare cover somatic prostheses?
As with other pieces of durable medical equipment, Medicare does help pay for the cost of somatic prostheses if you qualify. You are still responsible for paying for 20 percent of the cost of the product; however, Medicare Part B will take care of the other 80 percent. You will also have to meet your plan's deductible.
How do I qualify for coverage?
To get coverage for your somatic prostheses, you must have a doctors note from a physician who is an enrolled member of the national health care program. The doctor must determine that you require the device to restore function of or to replace a body part. Medicare Part B will only help pay for the cost of your prosthetic hand, finger or toe if you if it is surgically implanted in an inpatient hospital setting. If you get it attached in an outpatient hospital setting, you may have to pursue coverage through your Part B plan.
Where do I get somatic prostheses?
You can buy a prosthetic hand, finger or toe from a durable medical equipment supplier. The supplier must specialize in this type of device. You will work closely with a professional who will help develop the prosthesis to properly fit your body and meet your specific needs. When buying your prosthesis, be sure to go through a manufacturer is under contract with or has been approved by the national health care program. Additionally, you should have the price of your device approved by Medicare before moving forward with the purchase. Otherwise, you may find that your plan does not provide coverage, and you may end up having to pay more than expected out of pocket.