MAXCenters Plan prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
MAXCenters Plan 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 MAXCenters Plan covers
Prosthetic devices
MAXCenters Plan 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)
- Bionic and myoelectric prosthetics (when medically necessary)
- Prosthetic socket replacements and adjustments
- Cosmetic covers and sleeves
Orthotic devices
MAXCenters Plan 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 MAXCenters Plan coverage works
Understanding MAXCenters Plan
MAXCenters Plan (VillageCareMAX) is a Dual Advantage plan serving New York City seniors who have both Medicare and Medicaid. It's part of the HomeFirst family of health plans.
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 MAXCenters Plan to verify your coverage and confirm what you'll owe out-of-pocket.
03
We submit prior authorization
MAXCenters Plan requires prior authorization for prosthetics and orthotics. We handle all documentation and follow up with their 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 MAXCenters Plan directly
After delivery, we submit claims directly to MAXCenters Plan. You'll receive an Explanation of Benefits showing what was paid and any remaining balance.
What you'll pay with MAXCenters Plan
Understanding your out-of-pocket costs
As a Dual Advantage plan (Medicare and Medicaid), MAXCenters Plan covers prosthetics and orthotics with little to no out-of-pocket costs for most members.
Medicaid coverage typically eliminates Medicare cost-sharing, meaning:
$0 deductible
$0 copays
$0 coinsurance
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 MAXCenters Plan coverage easy
We verify benefits before you commit
You'll know exactly what MAXCenters Plan covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to MAXCenters Plan and follow up until authorization is approved.We submit all documentation to MAXCenters Plan and follow up until authorization is approved.
We bill MAXCenters Plan directly
You don't submit claims. We handle all billing and follow up 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 MAXCenters Plan resources
Access your benefits and health information.
Contact MAXCenters with questions about your plan or benefits. Customer Service: 1-866-783-7978
Learn about Medicare Part B coverage for prosthetics and orthotics.
Information for Medicaid members.
Common questions about MAXCenters Plan coverage
Does MAXCenters Plan cover prosthetics and orthotics?
Yes. MAXCenters Plan covers medically necessary prosthetic and orthotic devices under Medicare and Medicaid guidelines.
Do I need a referral?
MAXCenters Plan is an HMO, so you may need a referral from your primary care physician. We’ll verify this when we check your benefits.
How long does MAXCenters Plan authorization take?
Prior authorization typically takes 5-10 business days. We follow up throughout the process.
What if my prosthetic needs repairs?
MAXCenters Plan covers medically necessary repairs and adjustments.
Does MAXCenters Plan 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.
I have both Medicare and Medicaid. Will I owe anything?
Most dual-eligible members have no out-of-pocket costs for medically necessary prosthetics and orthotics.
Locations serving MAXCenters Plan members
Orthotics Ltd serves MAXCenters Plan 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 MAXCenters Plan benefits?
