Wellcare CalViva Health Dual Align (HMO D-SNP): Prosthetic Devices and Related Supplies

Prosthetics replace or restore lost functionality and include everything from orthotic shoes to implants to artificial limbs.

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Cost

$0 copay for Medicare-covered

Prior Authorization Required

Yes, for orthotics and prosthetics but not medical supplies

Provider Referral or Order Required

Yes

How To Receive

Details on how to apply

$0 copay for Medicare-covered prosthetic or orthotics.
$0 copay for Medicare-covered medical supplies related to prosthetic devices.

Obtain an order from your loved one's primary care provider or other specialist for a prosthetic device.

This may take place in the course of existing treatment, such as with a cardiologist for heart arrhythmia.

Devices (other than dental) that replace all or part of a body part or function. These include but are not limited to testing, fitting, or training in the use of prosthetic and orthotic devices; as well as: colostomy bags and supplies directly related to colostomy care, pacemakers, braces, prosthetic shoes, artificial limbs, and breast prostheses (including a surgical brassiere after a mastectomy). Includes certain supplies related to prosthetic and orthotic devices, and repair and/or replacement of prosthetic and orthotic devices. Also includes some coverage following cataract removal or cataract surgery

Availability

Ongoing, and as needed for repair or replacement

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Prosthetic devices are devices (other than dental) that replace all or part of a body part or its function. For example, a pacemaker replaces the electrical signals in the heart, orthotic shoes replace structures in the feet that are missing or damaged, and a colostomy replaces part of the bowel.

Prosthetics and Orthotics

Braces for ankle, foot, knee, back, neck, spine, hand, wrist, elbow
Artificial eyes
Artificial limbs
A surgical brassiere after mastectomy, and some types of breast prostheses
Devices to replace an internal body organ or function of the organ (colostomy supplies, oral and intravenous nutrition, pacemakers, and more).
Orthopedic shoes

Also included are certain supplies related to prosthetic devices and repair and/or replacement of prosthetic devices. There may also be some coverage following cataract removal or cataract surgery (see Vision Care benefit).

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