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Bill

LB 410

Require insurance coverage of prosthetics and orthotics

109th Legislature (2025-2026) Introduced by John Cavanaugh

Requires private and self-funded plans to cover prosthetics and orthotics at least equal to Medicare as of 2024, including repairs and nonparticipating provider access.

Title printed. Carryover bill
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WeVote Research Nonpartisan
Bill Summary · LB 410

Summary of Nebraska LB 410 (2025)

Overview

  • Bill Number: LB 410
  • Title: Require insurance coverage of prosthetics and orthotics
  • Introduced: January 17, 2025
  • Primary Sponsor: Senator John Cavanaugh
  • Committee: Banking, Commerce and Insurance
  • Hearing: Notice of hearing for March 10, 2025
  • Status: In committee proceedings; hearing scheduled

LB 410 aims to guarantee insurance coverage for prosthetics and orthotics that are medically necessary, aligning such coverage with Medicare-level benefits and extending protections to a broad range of health plans.

What the bill would do

  • Require coverage for prosthetics and orthotics in:
    • Individual and group health insurance policies delivered, issued for delivery, or renewed in Nebraska
    • Hospital, medical, or surgical expense-incurred policies
    • Self-funded employee benefit plans (to the extent not preempted by federal law)
  • Mandate that the coverage at minimum equals the coverage provided under the Medicare program as of January 1, 2024 (per specified Medicare statutes and related regulations).
  • Ensure coverage supports the most appropriate prosthetic or orthotic as determined by a physician, including repair or replacement when medically necessary.
  • Allow the insured to obtain prosthetics/orthotics from nonparticipating prosthetists with access to medically necessary care, services, and components, on par with out-of-network protections for other benefits.
  • Prohibit annual or lifetime dollar limits specifically on prosthetics and orthotics beyond any aggregate limits that apply to all covered benefits.

Key provisions and definitions

  • Definitions:
    • Orthotic: A custom-fitted or custom-fabricated medical device applied to the body to correct a deformity, improve function, or relieve symptoms.
    • Prosthetic: Artificial legs and arms and related components, including replacements due to changes in the patient’s condition.
  • Coverage standards:
    • Coverage must be at least Medicare-equivalent for prosthetics/orthotics as of 2024.
    • Coverage may be restricted to the most appropriate device as determined by a physician, including repairs/replacements as needed.
  • Provider access:
    • Insurers may require prosthetics/orthotics be furnished by a contracted prosthetist, but insured individuals retain access to nonparticipating providers for medically necessary care on par with other out-of-network benefits.

Applicability and scope

  • Applies to most private health insurance products and self-funded plans, subject to federal preemption limits (i.e., to the extent not preempted by federal law).
  • Excludes policies that provide coverage for a specified disease or other limited-benefit coverage, in specific circumstances noted in the bill.

Timeline and procedural notes

  • Introduced: January 17, 2025
  • Referred to Committee: January 22, 2025
  • Hearing: Scheduled for March 10, 2025
  • Ongoing legislative actions and potential amendments will be set by the Banking, Commerce and Insurance Committee.

Potential impact

  • Beneficiaries with amputations or requiring orthotics could gain more consistent, Medicare-comparable coverage for devices, services, and replacements.
  • Insurers and self-funded plans may need to adjust mandates to ensure Medicare-aligned coverage, avoid separate prosthetics/orthotics caps, and maintain provider access options (contracted vs. nonparticipating).
  • Providers (prosthetists/orthotists) may see changes in billing practices and network participation requirements.

Compiled from official sources — confirm details with the bill’s official record.

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