Imagine needing a prosthetic limb to walk, work, or even live a normal life, only to have your insurance company tell you it’s “not medically necessary.” That’s exactly what’s happening to amputees like Michael Adams, and it’s not just frustrating—it’s downright outrageous.
Michael, 51, lost his right leg to cancer 40 years ago, and since then, he’s had to replace his prosthetic leg more times than he can count. His latest health plan, a gold-level policy from the Colorado marketplace, promised to cover prosthetics like the high-tech knee he uses to prevent falls. This knee, which costs about $50,000, has a microprocessor that adjusts to different surfaces and stiffens up to stop a fall before it happens.
But when Michael’s old leg finally wore out, and he needed a new one, his insurance flatly refused. Even though his doctor had prescribed the same prosthetic knee for years, the insurer said it wasn’t “medically necessary.” In other words, it wasn’t something Michael needed to live a normal life.
Without that knee, Michael says, “It would be like going back to a wooden leg, like when I was a kid. It’s the difference between walking and falling.” But his insurance didn’t care. “It’s ridiculous,” he told CBS News. “How can they say it’s not necessary when my doctor has been prescribing it for years?”
The story gets even more infuriating when you realize that people who need joint replacements—like knee or hip surgeries—don’t face the same obstacles. Insurance companies have no problem covering those procedures, even when they cost over $68,000. But when it comes to a prosthetic limb, they act like it’s some kind of luxury item. It’s the same knee joint, but with plastic instead of skin, so why the double standard?
Amputee advocates are furious about this blatant discrimination. “Insurance will cover a knee replacement if it’s covered in skin, but if it’s covered in plastic, they won’t pay for it,” says Dr. Jeffrey Cain, a family physician and amputee who lost both legs in an airplane accident. “That’s just wrong.”
The fact is, over 2.3 million people in the U.S. are living with limb loss, and that number is expected to double as the population ages and more people lose limbs due to diabetes, trauma, and other medical conditions. Yet despite the need, fewer than half of people who lose a limb are actually prescribed a prosthetic. Why? Because insurance companies routinely deny coverage, calling the devices “experimental” or “not medically necessary,” even though advanced prosthetics, like Michael’s high-tech knee, have been in use for decades.
Here’s where it gets even worse: Some states have passed laws requiring insurance companies to cover prosthetic limbs in the same way they cover other medical services. Colorado, for example, passed a law mandating insurers cover prosthetics. But those laws don’t apply to everyone—only those with insurance plans regulated by the state. Most private health plans aren’t covered, leaving many amputees stuck with massive out-of-pocket costs or outright denials.
Medicare, which covers millions of seniors and people with disabilities, only pays 80% of the cost of prosthetic limbs, leaving the rest up to the patient. And a recent government report found that only 30% of Medicare beneficiaries who lost a limb in 2016 actually received a prosthetic within three years. That’s right—most people who lose a limb don’t even get the prosthetic they need, despite having Medicare.
Even with insurance, costs can be astronomical. Michael Adams had to pay $4,000 out of pocket for his new prosthetic leg, despite the fact that his insurer had approved it on appeal after initially denying him. “We’re lucky we could afford that 20%,” Michael says, adding that he’s a self-employed consultant. “But most people don’t have that kind of money lying around.”
That’s the reality for many amputees. While some can afford to pay the co-insurance or take out loans, many simply can’t. For them, even the most basic prosthetic is out of reach.
Take Leah Kaplan, for example. Leah was born without a left hand and never had a prosthetic until a few years ago. She got a prosthetic hand designed for cycling, and her insurance covered it. But when she tried to get approval for a prosthetic hand for everyday use—a myoelectric hand that moves in response to electrical impulses—her insurer turned her down. The hand would cost over $46,000 without insurance, a price Leah simply can’t afford.
Despite working with her doctor and appealing the decision three times, Leah’s insurer has refused to approve her prosthetic hand. “I’ve been waiting for this for so long, and now I’m stuck,” Leah says. “It’s not a luxury—it’s something I need to live my life.”
This isn’t just an issue of health coverage—it’s about basic human dignity. People who have lost a limb deserve to live without being treated like second-class citizens by their own insurance companies. Prosthetic limbs aren’t a luxury; they’re a necessity for amputees to walk, work, and participate in daily life.
