Humana prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
Humana 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 Humana covers
Prosthetic devices
Humana 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
Humana 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 Humana coverage works
Understanding Humana plan types
Humana offers several plan types in New York:
- Humana Medicare Advantage (HMO, PPO, PFFS plans)
- Humana Medicare Supplement (Medigap)
- Humana Medicaid (in select states)
Humana Commercial plans (employer-sponsored)
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 Humana to verify your coverage, check your deductible, and confirm what you'll owe out-of-pocket.
03
We submit prior authorization (if needed)
Some Humana plans require prior authorization for prosthetics and orthotics. We handle all documentation and follow up with Humana'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 Humana directly
After delivery, we submit claims directly to Humana. You'll receive an Explanation of Benefits showing what Humana paid and any remaining balance.
What you'll pay with Humana
Medicare Advantage members
Humana Medicare Advantage members pay according to Medicare Part B guidelines:
Medicare Part B deductible (if not yet met)
20% coinsurance after deductible
Some Humana Medicare Advantage plans offer enhanced benefits with lower cost-sharing or $0 copays for certain DME items.
Medicare Supplement (Medigap) members
If you have Original Medicare with a Humana Medicare Supplement plan, your Medigap policy helps cover Medicare cost-sharing. Many Medigap plans cover the 20% coinsurance.
Commercial plan members
Cost-sharing depends on your specific employer-sponsored plan:
- Deductible (if not yet met)
- Copay or coinsurance per item
- Out-of-pocket maximum
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 Humana coverage easy
We verify benefits before you commit
You'll know exactly what Humana covers and what you'll owe before we start creating your device.
We handle all prior authorizations
If your Humana plan requires prior authorization, we submit all documentation and follow up until approved.
We bill Humana directly
You don't submit claims. We handle all billing and follow up with Humana 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 commercial plans for decades. We know how Humana works.
Helpful Humana 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 Humana plans).
Contact Humana with questions about your plan or benefits. Medicare Advantage: 1-800-457-4708 Commercial Plans: 1-800-448-6262
Learn about Medicare Part B coverage for prosthetics and orthotics.
Common questions about Humana coverage
Does Humana cover prosthetics and orthotics?
Yes. Humana covers medically necessary prosthetic and orthotic devices across all plan types.
Do I need a referral?
It depends on your plan type. Humana HMO plans typically require referrals; PPO plans often do not. We’ll verify this when we check your benefits.
How long does Humana authorization take?
Prior authorization typically takes 5-10 business days. We follow up with Humana throughout the process.
Does Humana cover pediatric prosthetics?
Yes. Humana covers pediatric prosthetics with coverage for growth-related replacements.
What if my prosthetic needs repairs?
Humana covers medically necessary repairs and adjustments.
Does Humana 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.
Locations serving Humana members
Orthotics Ltd serves Humana 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 Humana benefits?
