Healthcare plans in most provinces will help pay for lower-limb prosthetics, but coverage rules are complex, and costs often exceed government funding limits. Many people turn to alternative funding sources to cover the expenses associated with getting a prosthetic leg.
If you’re a business owner, independent contractor, or self-employed, a Health Spending Account (HCSA) is one viable option to cover prosthetic costs. If you have employees, offering an HCSA is also an excellent addition to your group benefits plan, as it will cover a long list of medical procedures—including prosthetics. Let’s take a closer look at prosthetic leg costs in Canada and funding options for prosthetics.
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Types of Prosthetics and Their Costs
A prosthetic leg can cost anywhere between $5,000 and $100,000. Unfortunately, the initial purchase isn’t the final cost of owning the device, either.
Not only does getting a prosthetic require several doctor visits to create a custom-fit prosthesis, but learning to use it requires weeks, sometimes months, of physical therapy sessions. Learning how to walk with an artificial device takes a lot of time, effort, and professional assistance, which is why it takes a long time to be comfortable using it.
Five-year projected leg prosthetic costs can range from around $80,000 to nearly $290,000. Worse, the equipment often needs to be replaced within five years. Having a prosthetic is a lifelong expense.
The type of device also plays a role in the cost of a leg prosthetic. Most people chose a basic model, which uses a mechanical cable-fed control system to mimic muscle movement. A more hi-tech version of a prosthetic leg uses computers and sensors to help the device move, but costs can exceed $100,000.
How Much Does an Above-the-Knee Prosthetic Leg Cost?
Above-the-knee or transfemoral amputations are common here in Canada, but not everyone receives a prosthetic leg after losing a limb. These devices include a foot, pylon or limb, and knee joint, as well as a socket for the remaining portion of the leg, a control system, and a liner.
Because transfemoral amputations require a full-leg prosthesis, they tend to be more expensive than below-knee prosthetics. Basic device costs often range between $6,800 to $7,200.
How Much Does a Below-Knee Prosthesis Cost?
A below-the-knee prosthesis or prosthetic lower leg includes many of the same components as a full-leg prosthetic, including the foot, ankle, socket, and pylon frame. It can also include a suspension system to hold the prosthesis to the residual limb. Depending on the location of the amputation, it may not have a knee joint.
The price of a basic lower leg prosthesis can range between $4,200 and $5,500. Again, the more advanced the prosthetic, the more expensive it will be.
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Prosthetic Leg Funding Options
Nearly every province—8 out 10—offers some form of prosthetic coverage. Those with 100% coverage for lower limbs include:
- British Columbia
- New Brunswick
- Nova Scotia
Ontario offers 75% coverage, while Newfoundland and Labrador Prince Edward Island don’t cover lower-limb prosthetics. However, even provincial plans that offer full coverage often have complicated qualification rules. Coverage limits are also often well below the actual costs of getting a prosthetic leg.
People often have to resort to fundraising, personal resources, and private insurance to pay for their prosthetic expenses. Another way to pay for artificial legs is through employer-based group benefits. If you are an independent contractor or self-employed, you can set up a Health Spending Account (HCSA) for yourself and turn your after-tax medical expenses into before-tax business deductions.
If you have employees, Health Spending Accounts are also an excellent addition to any group benefits plan. An HCSA is a flexible program that supplements private or provincial insurance to pay for uncovered treatments, supplies, and services. Besides prosthetics, you or your employees can use an HCSA to pay for, among other things:
- Prescription medication
- Paramedical services like massage therapy and acupuncture
- Cosmetic surgery
- At-home care
Not only will the HCSA help pay for any prosthesis, but it can be used for related medical expenses like physical therapy.
Turn to Group Benefits to Cover Prosthetic Limb Costs
Paying for a prosthetic leg out-of-pocket is nearly impossible for many residents due to high continual costs. Many Canadians have to find alternative means to fund the expenses. At Group Enroll, we help business owners find affordable group insurance products from the nation’s top insurance companies.
If you’re interested in exploring an HCSA for yourself or your employees, fill out our quick quote form to get started. You can also email us at [email protected] with any questions. We’re located at 10 Great Gulf Drive, Unit 5, Vaughan, ON, L4K 5W1.