VillageCare prosthetics and orthotics coverage
We handle the paperwork. You focus on recovery.
VillageCare 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 VillageCare covers
Prosthetic devices
VillageCare 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
VillageCare 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 VillageCare coverage works
Understanding VillageCare
VillageCare is part of the HomeFirst family of health plans, which also includes VillageCareMAX (Dual Advantage) and ElderPlan. VillageCare primarily serves New York City seniors through Medicare Advantage and Medicaid managed care 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 VillageCare to verify your coverage and confirm what you'll owe out-of-pocket.
03
We submit prior authorization
VillageCare requires prior authorization for prosthetics and orthotics. We handle all documentation and follow up with VillageCare'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 VillageCare directly
After delivery, we submit claims directly to VillageCare. You'll receive an Explanation of Benefits showing what VillageCare paid and any remaining balance.
What you'll pay with VillageCare
Understanding your out-of-pocket costs
As a Medicare Advantage or Medicaid managed care plan, VillageCare covers prosthetics and orthotics under applicable guidelines.
Medicare Advantage members pay:
Medicare Part B deductible (if not yet met)
20% coinsurance after deductible
Medicaid members typically have:
- No copays, deductibles, or out-of-pocket costs
Dual-eligible members (Medicare and Medicaid)
If you're dual-eligible and have VillageCareMAX, 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 VillageCare coverage easy
We verify benefits before you commit
You'll know exactly what VillageCare covers and what you'll owe before we start creating your device.
We handle all prior authorizations
We submit all documentation to VillageCare and follow up until authorization is approved.
We bill VillageCare directly
You don't submit claims. We handle all billing and follow up with VillageCare 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 VillageCare resources
Access your VillageCare benefits and health information.
Contact VillageCare 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 VillageCare coverage
Does VillageCare cover prosthetics and orthotics?
Yes. VillageCare covers medically necessary prosthetic and orthotic devices under Medicare and Medicaid guidelines.
Do I need a referral?
VillageCare 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 VillageCare authorization take?
Prior authorization typically takes 5-10 business days. We follow up with VillageCare throughout the process.
What if my prosthetic needs repairs?
VillageCare covers medically necessary repairs and adjustments.
Does VillageCare 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 VillageCare members
Orthotics Ltd serves VillageCare 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 VillageCare benefits?
