ArchCare prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
ArchCare 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 ArchCare covers
Prosthetic devices
ArchCare 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
ArchCare 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 ArchCare coverage works
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 ArchCare to verify your coverage, check your deductible, and confirm what you'll owe out-of-pocket. You'll know the costs before we begin.
03
We submit prior authorization (if needed)
ArchCare Medicare Advantage plans typically require prior authorization for prosthetics and orthotics. We handle all the paperwork and follow up with ArchCare'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 ArchCare directly
After delivery, we submit claims directly to ArchCare. You'll receive an Explanation of Benefits showing what ArchCare paid and any remaining balance.
What you'll pay with ArchCare
Understanding your out-of-pocket costs
ArchCare is a Medicare Advantage plan serving the Archdiocese of New York community. As a Medicare Advantage plan, prosthetics and orthotics are covered under Medicare Part B guidelines. Most ArchCare members pay:
Medicare Part B deductible (if not yet met)
20% coinsurance after deductible
Some ArchCare plans offer enhanced benefits with lower cost-sharing. We’ll verify your specific plan details.
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 ArchCare coverage easy
We verify benefits before you commit
You'll know exactly what ArchCare covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to ArchCare and follow up until authorization is approved.
We bill ArchCare directly
You don't submit claims. We handle all billing and follow up with ArchCare 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 plans for decades. We know their requirements and how to get approvals efficiently.
Helpful ArchCare resources
Access your ArchCare benefits and health information.
Contact ArchCare with questions about your plan or benefits. Customer Service: 1-866-277-2593
Learn about Medicare Part B coverage for prosthetics and orthotics.
Common questions about ArchCare coverage
Does ArchCare cover prosthetics and orthotics?
Yes. ArchCare covers medically necessary prosthetic and orthotic devices under Medicare Part B guidelines.
Do I need a referral?
It depends on your specific ArchCare plan. We’ll verify this when we check your benefits.
How long does ArchCare authorization take?
Prior authorization typically takes 5-10 business days. We follow up with ArchCare throughout the process.
Does ArchCare cover pediatric prosthetics?
ArchCare is a Medicare Advantage plan primarily serving seniors. Pediatric coverage would be unusual, but we’ll verify if you have questions.
What if my prosthetic needs repairs?
ArchCare covers medically necessary repairs and adjustments under Medicare guidelines.
Does ArchCare cover bionic or myoelectric prosthetics?
Yes, when medically necessary and prescribed by your physician.
How often can I get a replacement prosthetic?
Replacement frequency follows Medicare guidelines—typically every 3-5 years when medically necessary.
Locations serving ArchCare members
Orthotics Ltd serves ArchCare 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 ArchCare benefits?
