While people often associate helmets with children, cranial orthotics are a treatment option for adults, too. That said, figuring out how to pay for cranial devices can be complicated. Before we discuss which Medicare plan covers this equipment, let’s look at a few common questions:
What are cranial helmets? What is the best kind of headgear for you? How and when does Medicare cover the cost? And lastly, how can a Medicare Advantage or Medigap plan help pay for it? We will answer all of these questions and more, but first, let’s look at the basic function of these devices.
What are Cranial Helmets?
Cranial orthosis refers to a type of headgear that can protect or mold the skull. However, cranial orthoses (also known as cranial bands) can either help with long term bone growth or protection (short term or long term) from head trauma. Doctors prescribe this type of headgear for various conditions in both children and adults.
Cranial Helmets for Children
- Deformational Plagiocephaly – This is a condition in which part of an infant’s head does not grow properly due to pressure. Non-positional plagiocephaly, also known as congenital plagiocephaly, refers to abnormal skull shapes present at birth. Both conditions can range from moderate to severe plagiocephaly.
- Craniosynostosis – This is a condition in which bones in the skull join together too early. Craniosynostosis can also vary from moderate to severe.
- Surgery – If an infant requires cranial surgery, a doctor may prescribe headgear as part of the post-operative therapy.
Cranial Helmets for Adults
- Protection – If you are at risk of head injuries, your doctor may prescribe headgear. Disabilities, seizures, or even poor balance can all increase the risk of head injury.
- Post Injury – When a head or brain injury has already occurred, your doctor may prescribe headgear. A helmet can protect the brain, head, or neck from further injury.
- Surgery – After surgery to the head, the brain or skull may be sensitive to any impact. Surgery to correct skull deformities often requires medical devices to help proper bone growth as well.
Are cranial helmets safe?
Yes, as long as a doctor prescribes a cranial helmet, it will be completely safe to use. A cranial helmet does not apply a lot of much pressure to the head or neck. It simply allows growing skulls to form into a more natural shape. It can also help protect the head from injury. So, not only do cranial bands not pose a risk to your health, but they can actually make you safer!
What is the Best Helmet Therapy for You?
The best cranial helmet for you will depend on your condition and needs. That said, certain headgear works better for some patients than others. So, let’s take a look at your options:
Remolding cranial headgear is a hard-shelled device that works to keep the skull from growing abnormally. Doctors often reserve this headgear for infants with skull deformation. However, a doctor may prescribe a remodeling helmet for an adult after surgery to the skull.
As the name implies, a full-coverage (complete) helmet provides protection for most of the head, neck, and face. This device includes a helmet for the top, sides, and back of the head. A complete helmet often has a face mask that covers the mouth, chin, and part of the neck.
Despite the high level of protection, you can take these off at any time. That said, doctors often prescribe this type of headgear for patients who could injure themselves. For example, complete devices are common for people with seizures. As a result, people usually wear them for long periods of time.
A partial-coverage helmet provides less protection than a complete device. However, it offers more comfort. Partial-coverage headgear is more comfortable to take on and off. They also have more gaps and little to no facial protection.
Doctors often prescribe this kind of headgear for short-term protection. For example, if you get surgery, your doctor might prescribe this headgear as part of your therapy. In this case, you would only need to wear the device until you fully recover from the surgery.
A hard-top (hard shell) device consists of a hard plastic or polycarbonate material, similar to a football helmet. They have a soft foam interior for comfort and a hard shell exterior for better shock absorption. You can get hard-top headgear for both full and partial coverage.
A Soft-top (shoft shell) device only uses soft foam. While they may not provide the same protection as hard-top headgear, they are lighter and more comfortable to wear. You can get soft-top headgear for both full and partial coverage.
As long as your doctor deems it “medically necessary,” Medicare treats headgear as Durable Medical Equipment (DME). Since Part B covers DME, you can expect Part B to pay for it. Once you’ve met your deductible, Part B will pay for 80% of the cost. You will need to pay the remaining 20%.
AGENT TIPA Medicare Supplement plan can help cover the 20% that Medicare Part B does not cover.
The costs of headgear can vary. Some headgear treats skull deformities, while some just protect the head and neck. Remodeling headgear usually costs between $1,000 to $3,000. Protective headgear tends to be far less expensive. However, the type of device (full or partial) and material (hard or soft) will also affect the cost.
How Can a Medicare Supplement or Advantage Help?
Medicare Advantage is a private insurance plan that provides the same benefits as Parts A and B. Advantage plans also offer extras like vision, dental, and hearing. Since it includes Part B, Advantage can also cover headgear as durable medical equipment. So, you can benefit from Part A and B benefits, plus a few extras.
You can also save on cranial therapy with Medicare plus a supplement (Medigap) plan. Medigap helps you pay for many of the out-of-pocket costs of therapy. In essence, it “fills in the gaps.”
Bluewave Is Here to Help
So, which Medicare plan covers cranial helmets? In short, it will depend on your needs and conditions. It covers prescribed headgear as DME. Regardless of the type of headgear you need, your doctor must prescribe one for Part B to pay for it.
Even then, there are still costs you will need to consider. Many people don’t realize that they will need to pay for all of the extra expenses that come with headgear and cranial remolding therapy. This is where Medicare Advantage or Medigap health care with Bluewave Insurance can help.
thumbIf you have further questions about Medicare or want to learn about cost-sharing Medigap options, call us at 800-208-4974 today!