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How to Get Financial Assistance for Prosthetic Services and Devices

    Acquiring a prosthetic limb or an assistive device can be expensive. The prosthetic fitting process typically costs less than $10,000 for a basic prosthesis and can go up to more than $70,000 for an advanced prosthetic limb. Many durable medical devices, like electronic wheelchairs and ramps, are also expensive. So, it's best to get financial assistance where you qualify.

     Apply for financial assistance for prosthetic devices and services with these tips.

    In this article, we compiled a list of government organizations that can offer financial assistance for prosthetic devices, rehabilitative services, and other assistive devices that are essential for your daily life.

    How to prepare to apply for financial assistance  

    Before sending in your application, it's important to determine or organize these three things: 

    Determine what assistive device you need  

    To update outdated equipment like crutches and wheelchairs, you must determine the exact item you need, including the manufacturer and model. You also need to decide where to purchase the item.

    Get a prescription  

    A prescription from a physician, physical therapist, or other rehabilitation professionals will strengthen your application. And consulting your healthcare provider will also help you determine the features you need in a prosthetic device.

    Organize personal information  

    Organized information is critical to a successful assistance application. Keeping the following information will also help you avoid unnecessary delays:

    • Primary disability – cause of disability and when it occurred.

    • Secondary disability – cause of disability and when it occurred.

    • Employment history

    • Family gross income

    • Monthly expenses include utilities, rent or mortgage payments, medical expenses, loans and bills, etc.

    • Health insurance information

    • Dependents – name, age, and relationship.

    Once you've accomplished the tasks above, allot some time to consider how you want to justify your request for financial assistance. Typically, government programs require applicants to prepare a justification statement. State vocational rehabilitation agencies require applicants to demonstrate how the equipment or service will enhance their ability to keep or get a job.

    However, if employment is impossible for your condition, then the justification statement must show that the device or service will improve your independence. Other funding sources will have their own set of requirements.

    Where to find financial assistance for prosthetic devices  

    Medicare   

    Call: 800/633-4227

    Website: medicare.gov

    For more information on the types of devices covered, how coverage works, and any costs you may need to pay out-of-pocket, visit medicare.gov/coverage/prosthetic-devices.html.

    Medicaid  

    Call: 800/633-4227

    Website: Medicaid.gov

    You may also be eligible for Medicaid and State Children's Insurance Program coverage if you are on Medicare. Check your eligibility here: medicaid.gov/medicaid/eligibility.

    Individuals with disabilities eligible for Medicaid are entitled to all medically necessary services. Furthermore, the Affordable Care Act considers prosthetics and rehabilitative services as Essential Health Benefit (EHB). So, states that have revamped their Medicaid programs must provide these benefits to people who recently qualified for coverage. Find out more about your state's Medicaid programs here: medicaid.gov/state-overviews/index.html.

    Veterans Administration (VA)  

    Call: 1-877-222-8387

    Website: va.gov

    To be eligible for VA healthcare, you must meet the following requirements:

    • You have been discharged from active military service under honorable conditions.

    • You must have served at least two years if you were discharged after September 7, 1980. But there's no time limit if you were discharged before that date.

    • You have served as a National Guard member or reservist for the entire period you were called to active duty, other than for training purposes only.

    For more information about the VA's Rehabilitation and Prosthetic Services, check prosthetics.va.gov.

    TRICARE  

    Website: tricare.mil

    This is the Department of Defense's healthcare program for active duty and retired uniformed service members, including their families. It covers prosthetic limbs, prosthetic devices, and prosthetic supplies necessary due to injuries resulting from trauma, disease, or congenital anomalies.

    For more information, check tricare.mil/CoveredServices/IsItCovered/Exclusions.aspx.

    Vocational Rehabilitation  

    U.S. Department of Labor National Contact Center

    Call: 866/487-2365

    Most states have vocational rehabilitation programs that provide employment assistance to people with limb loss or disabilities. They also offer assistance if a prosthetic limb or other adaptive device is required as a daily living aid. However, these programs' eligibility requirements and services vary depending on the state.

    Contact your state's Department of Health and Human Services office for more information.

    Private Insurance  

    Call: 800/318-2596

    Website: healthcare.gov

    The Affordable Care Act, also known as Obamacare, requires that every individual in the country has health insurance coverage. Not enrolling in health insurance means you must pay a yearly tax penalty. 

    If you already have an insurance plan, you can keep it if it meets minimum requirements. But if you need to sign up for a new private health insurance plan, you may do so through your employer or the new insurance exchanges called "marketplaces."

    For more information about open enrollment, please visit healthcare.gov.  

    Medical Discount Programs

    These programs negotiate with a partner of the Preferred Provider Organization (PPO) for their members to receive discounts on medical services and goods, like prescription drugs or nursing home care. While durable medical equipment, like wheelchairs and crutches, are often included in the benefits packages, prosthetic care is not mentioned.

    For more information, please visit consumer.ftc.gov/articles/0165-discount-plan-or-health-insurance.

    Besides the state and federally-funded sources of financial assistance mentioned above, you can also tap various non-profit organizations. It may be best to contact your amputee support group (if you're part of one), hospital, or your prosthetist.