Illinois Orthotic and Prosthetic Legislation

Illinois Passes Legislation Supporting Coverage of Custom Orthoses and Prostheses for Physical Activity

No single orthosis or prosthesis can replace the vast array of fundamental human movements lost from amputation, disease, or disorder. That’s why you may need specialized orthoses and prostheses designed for activities beyond just standing and walking. These specialized devices can help with movements like running, hopping, skipping, twisting, kneeling, jumping, swimming, dancing, biking, and more. They provide stability, prevent damage, and minimize injury to both your body and the device.

Illinois Legislative Activity

In 2023, Illinois passed a law (SB2195) that requires fully insured commercial health plans to provide coverage for custom orthotic and prosthetic care. Here’s what you need to know:

  • Eligibility Requirement: The law mandates that insurance companies provide coverage for orthotic and prosthetic care as determined by your physician to be the most appropriate model that is medically necessary to perform physical activities.
  • Orthosis and Prosthesis Types: This includes coverage for orthoses and prostheses needed to perform physical activities such as running, biking, swimming, and lifting weights, and to maximize the person’s whole-body health and strengthen the lower and upper limb function.
  • Essential Services and Supplies: Coverage also includes all services and supplies needed to use these orthoses and prostheses effectively, including repair and replacements when medically necessary.

Supported by So Every BODY Can Move, this law took effect on January 1, 2025.

Mary Running Blade

What does this mean for the citizens of New Illinois?

People of all ages may qualify for coverage. If you currently use an orthosis or prosthesis but struggle to participate in sports or other kinds of physical activities due to limitations of your daily use device, and you could benefit from the increased physical activity that a specialized device would provide, reach out to your orthotist or prosthetist to discuss whether you qualify.

Would you benefit from a specialized prosthesis?

  • Do you have trouble performing or participating in certain activities using your current everyday prosthesis?
  • Could increased physical activity improve your mental or physical health? How so?
  • How could exercising or increased physical activity improve your overall quality of life?
  • Are there any health concerns that could develop from increasing your physical activity?

Running requires different biomechanics than walking. When running, more push-off energy is generated by the ankle than during walking, and upon heel strike, the vertical impact of running can equal around four times one’s body weight. The good news is that there are prosthetic devices specifically designed for running to maximize shock absorption and energy return while improving stamina and minimizing injury.

Michael Oros, CPO, FAAOPPresident of Hanger Clinic