Frequently Asked Questions

Q: What is the difference between Medicare Part A & Part B?
A: The Medicare program is a federal health insurance program for people 65 years of age and older and certain disabled people under the age of 65. It is run by the Health Care Financing Administration of the United States Department of Health and Human Services. The Medicare program has two parts Hospital insurance (Medicare Part A) helps pay for inpatient Hospital care, inpatient care in a skilled nursing facility, home health care and hospice care. Medical insurance (Medicare Part B) helps pay for physicians' services, outpatient hospital services, durable medical equipment, and a number of other medical services and supplies that are not covered by Medicare Part A.

Q: Who is eligible for Medicare?
A: Medicare eligibility is determined by the Social Security Administration (SSA). An individual may become entitled through Social Security based on his or her own earnings or that of a spouse, parent or child. Anyone who becomes entitled to premium-free hospital insurance (Medicare Part A) is automatically enrolled in medical insurance (Medicare Part B), except in Puerto Rico. In order for an individual to be eligible for medical insurance (Medicare Part B), he or she must be a U.S. citizen and /or: 1) 65 years of age, 2) Under age 65 with permanent kidney failure or 3) Under age 65 and permanently disabled and entitled to SSA benefits. The Medicare program does not include persons who may have chosen early retirement and are receiving social security benefits, unless they meet one of the requirements shown.

Q: Will Medicare pay for diabetic shoes?
A: Medicare covers 1 pair of depth shoes and 3 pair of multi-density inserts per year. Coverage is limited to one of the following within 1 calendar year: 1 pair of off-the-shelf depth shoes and 3 additional pair of multi-density inserts. 1 pair of off-the-shelf depth shoes including a modification, and 2 additional pair of multi-density inserts. 1 pair of custom molded shoes and 2 additional pair of multi-density inserts.

Q: What should I look for in a prosthetic company?
A: Look for company that has a certified/licensed practitioner on staff. In addition, the facility should be accredited.

Q: For Medicare or private insurance to pay for durable medical equipment, do I need a prescription from the doctor?
A: A prescription is necessary for payment by insurance companies and Medicare, but not if paying cash.

Q: Will Medicare cover mastectomy products?
A: Yes, a breast prosthesis is covered for a patient who has had a mastectomy.

Q: Will Medicare pay for wheelchairs?
A: Yes, a wheelchair is covered if the patient's condition is such that without the use of a wheelchair, he/she would otherwise be bed or chair confined. An individual may qualify for a wheelchair and sill be considered bed confined. This basic requirement must be met for coverage of any wheelchair.

Q: How often can I replace my wheelchair through Medicare or private insurance?
A: A wheelchair may be replaced every 5 years.

Q: Will Medicare pay for standard walkers and related accessories?
A: Yes, if both of the following criteria are met: 1) It is prescribed by a physician for a patient with a medical condition impairing ambulation and there is a potential for ambulation, and 2) There is a need for greater stability and security than provided by a cane or crutches.

Q: Why does the first prosthesis not have a cover so it looks like a leg?
A: Medicare will pay for 2 legs in the first year as long as one is a prep-leg. The patient is first fitted with a prep-leg for training. In six to eight months, after the amputated leg shrinks, the patient is fitted for the second leg, the definitive prosthesis. This prosthesis is fabricated to match the patient's natural leg.

Q: Will the patient be able to drive a car with the right leg amputated?
A: Yes, however the patient must have some form of accelerator and brake modification. This can be done with installation of hand controls for the operation of the car or with a left foot accelerator pedal. An additional pedal is installed and connected to the right foot accelerator. In this way, the accelerator and brake pedal are controlled with the left foot.

Q: Will the patient be able to dance?
A: The answer is yes. Most patients get back to around 90 percent of the activities they were doing before surgery.