Wellcare prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
Wellcare 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 Wellcare covers
Prosthetic devices
Wellcare 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
Wellcare 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 Wellcare coverage works
Understanding Wellcare plan types
Wellcare (a Centene company) offers multiple plan types in New York:
- Wellcare Medicare Advantage (HMO, PPO, SNP plans)
- Wellcare Dual Complete (Medicare and Medicaid)
- Wellcare Medicaid Managed Care (in select states)
- Wellcare Prescription Drug Plans (Part D)
Coverage and cost-sharing vary by plan type. We’ll verify your specific 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 Wellcare to verify your coverage, check your deductible, and confirm what you'll owe out-of-pocket.
03
We submit prior authorization (if needed)
Most Wellcare plans require prior authorization for prosthetics and orthotics. We handle all documentation and follow up with Wellcare'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 Wellcare directly
After delivery, we submit claims directly to Wellcare. You'll receive an Explanation of Benefits showing what Wellcare paid and any remaining balance.
What you'll pay with Wellcare
Medicare Advantage members
Wellcare Medicare Advantage members pay according to Medicare Part B guidelines:
Medicare Part B deductible (if not yet met)
20% coinsurance after deductible
Some Wellcare Medicare Advantage plans offer enhanced benefits with lower cost-sharing or $0 copays for certain items.
Dual Complete members (Medicare and Medicaid)
If you have Wellcare Dual Complete, you may have little to no out-of-pocket costs. Medicaid often covers Medicare cost-sharing.
Medicaid members
If you have Wellcare through Medicaid, prosthetics and orthotics are covered with no copays, deductibles, or out-of-pocket costs.
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 Wellcare coverage easy
We verify benefits before you commit
You'll know exactly what Wellcare covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to Wellcare and follow up until authorization is approved.
We bill Wellcare directly
You don't submit claims. We handle all billing and follow up with Wellcare 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.
50+ years of insurance experience
We've worked with Medicare Advantage and Medicaid plans for decades. We know how Wellcare works.
Helpful Wellcare resources
Log in to check your benefits, view claims, and access your health information.
Search for in-network providers (Orthotics Ltd is in-network with most Wellcare plans).
Contact Wellcare with questions about your plan or benefits.
Medicare: 1-866-809-8009
Medicaid: Varies by state
Learn about Medicare Part B coverage for prosthetics and orthotics.
Common questions about Wellcare coverage
Does Wellcare cover prosthetics and orthotics?
Yes. Wellcare covers medically necessary prosthetic and orthotic devices across all plan types.
Do I need a referral?
It depends on your plan type. Wellcare HMO plans typically require referrals; PPO plans often do not. We’ll verify this when we check your benefits.
How long does Wellcare authorization take?
Prior authorization typically takes 5-10 business days. We follow up with Wellcare throughout the process.
Does Wellcare cover pediatric prosthetics?
Yes. Wellcare covers pediatric prosthetics with coverage for growth-related replacements.
What if my prosthetic needs repairs?
Wellcare covers medically necessary repairs and adjustments.
Does Wellcare cover bionic or myoelectric prosthetics?
Yes, when medically necessary and prescribed by your physician.
How often can I get a replacement prosthetic?
Replacement frequency depends on medical necessity. Medicare guidelines typically allow replacement every 3-5 years.
I have Medicaid through Wellcare. Will I owe anything?
Most Medicaid members have no out-of-pocket costs for medically necessary prosthetics and orthotics.
Locations serving Wellcare members
Orthotics Ltd serves Wellcare members throughout New York.
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 Wellcare benefits?
