MA H4549

Requires health insurers, MassHealth, and state employee plans to cover prosthetic and orthotic devices for both daily use and physical activities (running, biking, swimming, bathing), including repair and replacement.

Prohibits insurers from denying coverage for prosthetics or orthotics solely based on a person's actual or perceived disability, and bars denial of benefits that would be covered for non-disabled persons seeking similar functional restoration.

Mandates that cost-sharing for prosthetic and orthotic devices cannot be more restrictive than cost-sharing for inpatient physician and surgical services.

Requires health plans to include at least two in-network prosthetic/orthotic providers in the state, with full reimbursement to out-of-network providers when in-network options are unavailable.

Allows device replacement without "useful lifetime" restrictions when medically necessary due to patient condition changes, irreparable device damage, or when repair costs exceed 60% of replacement cost.