While many states under the Affordable Care Act have worked to establish coverage levels for prosthetic devices as an Essential Health Benefit, some states have done a better job than others. Unfortunately, one of the most egregious coverage restrictions is within New York State’s Insurance Exchange Marketplace. The benchmark plan selected as part of the New York State Marketplace has a provision that limits prosthetic coverage to “one prosthesis per limb per lifetime.” The Amputee Coalition is currently working with coalition groups, partner organizations, professionals and advocates in New York and Washington D.C. to get this restriction invalidated by the agencies that oversee the Affordable Care Act, including the Department of Health and Human Services. We are also working in the state of New York to raise awareness of this unbelievable provision and encourage the state to follow the Affordable Care Act and the intention of the law to provide adequate coverage for prosthetic devices in the marketplaces.
Working with local providers in New York, as well as Amputee Coalition advocates, and state and national organizations and coalitions, we will be looking to send out petitions to the community to let these agencies and the state know that this egregious provision will not be tolerated or accepted, and that they must revise these plan standards for future years to provide adequate coverage.
If you live in New York, please be sure to sign up to join the Amputee Coalition so that you receive updates about how you can help. If you don’t live in New York, but face any similar restrictions in prosthetic coverage and would like to get involved with the Amputee Coalition, sign up to join the Amputee Coalition and email us at State@Amputee-Coalition.org to let us know about issues you’ve faced so we can work to address them.