ElderPlan prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
ElderPlan covers custom prosthetics and orthotics—and Orthotics Ltd manages the entire insurance process from start to finish. Prescriptions. Prior authorization. Claims. We take care of it so you can focus on getting back on your feet.
What ElderPlan covers
Prosthetic devices
ElderPlan covers medically necessary prosthetic devices, including:
- Lower limb prosthetics (below knee, above knee, partial foot, hip disarticulation)
- Upper limb prosthetics (below elbow, above elbow, partial hand, shoulder disarticulation)
- Pediatric prosthetics (with coverage for growth-related replacements)
- Bionic and myoelectric prosthetics (when medically necessary)
- Prosthetic socket replacements and adjustments
- Cosmetic covers and sleeves
Orthotic devices
ElderPlan covers custom orthotic devices, including:
- Custom braces (ankle, knee, wrist, elbow, back, neck)
- Compression garments
- Spinal orthotics
- Custom-molded shoes and inserts
- Orthotic repairs and adjustments
Additional covered services
- Initial consultation and evaluation
- Custom fitting and adjustments
- Follow-up care and modifications
- Repairs and replacements (when medically necessary)
How ElderPlan coverage works
Understanding ElderPlan
ElderPlan is a Medicare Advantage plan (HMO and HMO-POS) serving New York City seniors. It’s part of HomeFirst, which also includes VillageCareMAX. Coverage follows Medicare Part B guidelines with additional benefits.
01
Get a prescription
Your physician provides a prescription for the prosthetic or orthotic device. We can help coordinate with your doctor's office if needed.
02
We verify your benefits
We contact ElderPlan to verify your coverage, check your cost-sharing, and confirm what you'll owe out-of-pocket.
03
We submit prior authorization
ElderPlan requires prior authorization for prosthetics and orthotics. We handle all documentation and follow up with ElderPlan's review team.
04
We create your custom device
Once approved, we scan or cast your limb, create a test socket or device, and work with you until the fit is perfect.
05
We bill ElderPlan directly
After delivery, we submit claims directly to ElderPlan. You'll receive an Explanation of Benefits showing what ElderPlan paid and any remaining balance.
What you'll pay with ElderPlan
Understanding your out-of-pocket costs
As a Medicare Advantage plan, ElderPlan covers prosthetics and orthotics under Medicare Part B guidelines. Most members pay:
Medicare Part B deductible (if not yet met)
20% coinsurance after deductible
Some ElderPlan options offer enhanced benefits with reduced cost-sharing or $0 copays for certain items. We’ll verify your specific plan details.
Dual-eligible members (Medicare and Medicaid)
If you're dual-eligible, you may have little to no out-of-pocket costs. Medicaid often covers Medicare cost-sharing.
We tell you what to expect upfront
Before we begin fabrication, we'll provide a clear estimate of your financial responsibility. No surprises.
Why Orthotics Ltd makes ElderPlan coverage easy
We verify benefits before you commit
You'll know exactly what ElderPlan covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to ElderPlan and follow up until authorization is approved.
We bill ElderPlan directly
You don't submit claims. We handle all billing and follow up with ElderPlan on your behalf.
We work with your doctor
We coordinate with your physician's office to ensure we have all necessary prescriptions and medical documentation.
Home visits available
If getting to our clinic is difficult, we come to you. We offer home visits throughout the New York area.
Helpful ElderPlan resources
Access your ElderPlan benefits and health information.
Contact ElderPlan with questions about your plan or benefits. Customer Service: 1-866-783-7978
Learn about Medicare Part B coverage for prosthetics and orthotics.
Common questions about ElderPlan coverage
Does ElderPlan cover prosthetics and orthotics?
Yes. ElderPlan covers medically necessary prosthetic and orthotic devices under Medicare Part B guidelines.
Do I need a referral?
ElderPlan is an HMO plan, so you may need a referral from your primary care physician. We’ll verify this when we check your benefits.
How long does ElderPlan authorization take?
Prior authorization typically takes 5-10 business days. We follow up with ElderPlan throughout the process.
What if my prosthetic needs repairs?
ElderPlan covers medically necessary repairs and adjustments under Medicare guidelines.
Does ElderPlan cover bionic or myoelectric prosthetics?
Yes, when medically necessary and prescribed by your physician.
Can you come to my home?
Yes. We offer home visits for patients who can’t travel to our clinic.
Do you work with nursing homes?
Yes. We partner with nursing homes throughout New York to provide prosthetic and orthotic services.
Locations serving ElderPlan members
Orthotics Ltd serves ElderPlan members throughout New York City and surrounding areas.
Our clinic:
Harriman, NY
We also offer:
- Home visits for patients who can’t travel
- Nursing home partnerships
- Emergency prosthetic services
Ready to use your ElderPlan benefits?
