Maryland health plans must cover braces and artificial limbs

Maryland Medical Assistance and certain health plans must cover orthoses, their parts, repairs, and eligible replacements. This applies to Maryland Medical Assistance and insurers, nonprofit health service plans, and health maintenance organizations offering hospital, medical, or surgical benefits under plans issued or delivered in Maryland. The law says Medical Assistance managed care plans do not have to cover more orthotic device codes than they covered on December 31, 2026. A plan must cover a replacement without continuous-use or useful-life limits when a provider finds it necessary because the patient's physical condition changed or, unless misuse caused it, the orthosis was irreparably changed. For an orthosis less than one year old, a plan may ask the provider to confirm the reason. Plans may not charge higher copays or coinsurance than for similar medical or surgical benefits, set a separate annual or lifetime dollar limit, or use medical-need rules stricter than Medicare's coverage database. Plans that use provider panels must follow state provider-network rules. This coverage applies to plans issued, delivered, or renewed in Maryland on or after January 1, 2027. The law takes effect on January 1, 2027.

Certain health plans must include all medically necessary prostheses for the listed activities. This applies to insurers, nonprofit health service plans, and health maintenance organizations offering hospital, medical, or surgical benefits under plans issued or delivered in Maryland. A prosthesis is an artificial device replacing all or part of a leg, arm, or eye. Medical-need rules may not be stricter than the indications and limits in Medicare's coverage database. This requirement applies to plans issued, delivered, or renewed in Maryland on or after January 1, 2027.