What Equipment Does Medicare Pay For
Medicare covers durable medical equipment if it is reusable such as wheelchairs and walkers and if your doctor prescribes it as medically necessary for use in your home.
In order for Medicare to pay for your wheelchair or walker, it must meet the following requirements:
- Only manual wheelchairs qualify as durable medical equipment. Power wheelchairs are only covered by Medicare when determined to be medically necessary .
- Depending on the circumstances, you may be required to either purchase the equipment or rent the equipment. In some situations, you may be given the choice to either purchase or rent.
- The use of a wheelchair or walker must be considered medically necessary and prescribed by a doctor.
- The wheelchair or walker must be appropriate for use in the home .
- The wheelchair or walker must be considered durable, or able to withstand repeated use and likely to last for three years or more.
- The item must serve a medical purpose.
Durable medical equipment is covered under Medicare Part B medical insurance.
Does Medicare Cover Walkers
Yes, Medicare does cover walkers and other similar durable medical equipment which is covered under Medicare Part B. You’ll need to meet certain requirements, however.
Learn more about Medicare coverage for walkers and other mobility devices, as well as some of the costs you may expect to pay.
Medicare will pay for any walker that is supplied by a provider who participates in Medicare, provided you meet the qualifications for coverage .
Range Of Home Health Benefits
Medicare does not cover:
- 24-hour care at home
- Custodial or personal care when this is the only home care you need.
- Household services such as shopping, cleaning and laundry when they are not related to your care plan.
- Meal delivery to your home
Medicares website has a search and comparison tool to help you find certified home health agencies in your area. If you have original Medicare, Parts A and B, you can choose any approved agency.
If you have a Medicare Advantage plan from a private insurance company, you may have to use an agency that the plan works with. Before you start receiving care, the agency should let you know, verbally and in writing, whether some of the services they provide are not covered by Medicare and what you would pay for them.
Editor’s note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.
You May Like: Is Insulin Pump Covered By Medicare
How Often Are Walkers Covered By Medicare And For How Many Years It Will Pay
When you are qualified for Medicare coverage for your walker, Medicare will pay for the purchase of your walker or rental, and it will also pay for its replacement if it is lost, stolen, broken, or damaged in an accident.
Medicare also offers to pay up for the repairs and damages of the walker due to everyday use.
However, Medicare will only replace or repair the walker if you have had it in possession for a lifetime. Medicare will pay for your walker depending upon the items life.
There is a maximum of 5 years to a minimum of 3 years time frame considered by Medicare for types of medical equipment.
When Does Medicare Cover Walkers For Seniors
In some cases, your doctor, nurse practitioner, or another qualified provider may supply walkers for seniors. For example, a nurse in the hospital might offer you one to use and take home with you. In those cases, according to Medicare, they will cover the equipment. This is true even if the entity who supplied you with your walker isnt contracted to supply durable medical equipment.
In other cases, you may need to fill your prescription for a walker with a contract supplier if you live in an area that participates in Medicares competitive bidding program for DMEs. Your provider may offer suggestions for local providers that have contracted with Medicare to sell walkers for seniors. If not, you can check with suppliers before you buy. You also have the option to contact Medicare or your private insurer for help.
If you live in a competitive bidding area and dont purchase your walker from a contract supplier, you could risk having your claim denied. Even if Medicare accepts your claim, you may have to pay more if the seller charges more than Medicare allows.
Read Also: Who Can Get Medicare Part D
What Costs You Need To Cover
If Medicare approves coverage of your wheelchair, you still have a financial obligation to meet. Customary with any health insurance, you must meet your Part B deductible for that year, then cover 20% of the Medicare-approved amount. Usually, this approved amount wont exceed the actual charge or fee Medicare sets for the item.
Medicare will generally pay for the most basic level of equipment needed. If you need upgrades or extra features and your supplier thinks Medicare wont cover them, youll need to sign an Advance Beneficiary Notice before receiving the item. On this waiver form, you must check the box stating you wish the upgrades and will agree to cover their full cost if Medicare denies coverage.
You may have to cover the full cost of your wheelchair if you get it from a supplier that isnt a contract supplier.
Will Medicare Cover An Upright Walker
Upright walkers fall under the same rules and regulations as all other walkers and rollators. So to determine if your upright walker will be covered by Medicare you need to answer the 4 eligibility questions in the affirmative: Is it medically necessary? Was it prescribed by a doctor, nurse, or podiatrist? Was it prescribed and supplied by those enrolled in Medicare? And is it cost effective?
Also Check: Can Permanent Residents Get Medicare
Does Medicare Cover Rollators
Mobility aids are an integral part in the lives of many Medicare recipients. They can help someone maintain quality of life and independence. Mobility aids are used to help people who have trouble walking independently, and can include wheelchairs, walkers, or rollators. Each of these pieces of medical equipment may be used in different circumstances depending on the specific needs of the patient.
Rollators may also be referred to as wheeled walkers and can be beneficial for individuals who require walking assistance wherever they go. Medicare insurance may provide coverage for these tools when they are ordered by a Medicare-approved physician and are deemed medically necessary.
What is a Rollator?A rollator is built like a walker, having a durable frame and three or four larger wheels at the base. Handlebars with comfortable grips are often included along with a seat that allows users to rest and take breaks as needed. Some of these products may include storage bags or baskets attached to the sides or front of the frame or a compartment that can be accessed by lifting the seat.
Rollators can differ in the features they come equipped with. One important feature for any rollator is adjustable handlebars. Selecting a product that can be adjusted to fit your height and arm requirements is critical to ensure both functionality and safety. Some products are adjustable to be used for children and adults alike.
Medicare Requirements For Rollators
You can admit it, you have walker envy. It happens to the best of us. Especially with the rise of the new and durable rollator walkers, it is okay to admit that your old cane just is not doing the trick anymore.
Maybe you really need a new walker for your health but you are afraid that you just dont have the money on your fixed income to afford a new model. Being caught between a tight budget and health concerns is something that millions of Americans deal with on a monthly basis.
That raises an important question. Are rollator walkers covered by Medicare?
The answer is, yes! There are some requirements to meet and potential fees to address but Medicare can and will cover the cost of your rollator walker if you qualify.
You May Like: Will Medicare Pay For A Toilet Seat Riser
So What Does All That Mean
Honestly, it is a lot of legalistic language that says the person getting the cane needs it to take care of themselves and that they can use it safely.
All of that MRADL stuff above is just the activities most of us do every day at home to take care of ourselves. Like, feeding ourselves, getting dressed, and going to the bathroom and so forth. So, Medicare wants to know that person getting the cane is unable to do one of those things because of their problem walking. An example is they live alone and cannot walk enough to get something to eat. Or, they are unable to make it to the bathroom on time because they walk slowly.
The second criteria are about safety. Medicare just wants to know that the prescriber has taken into account the safety of the senior who needs a cane. If they cannot safely use the cane, other equipment should be considered. Perhaps a walker with wheels, a rollator with seat, or even a wheelchair may be more appropriate.
The final criteria have always seemed a little weird to me. Medicare wants to know that the cane will actually fix the problem. If the user gets a cane, Medicare wants confirmation that the user can use the cane to the kitchen or bathroom now.
Durable Medical Equipment Items Medicare Covers
While the list below is not complete, and other items may be covered, the below are some examples of common durable medical equipment items often covered by Medicare Part B.
Some examples of Durable Medical Equipment Covered by Medicare:
This is not a complete list, and some equipment items are subject to specific conditions for coverage. To see more, .
Medicare does also cover certain prescriptions, medications and supplies that you may use with your durable medical equipment item.
If you are uncertain whether you may be covered by Part B for an item on this list, its best to reach out to your plan provider. If you dont see an item you need on this list, talk with your doctor or health care provider to see if its considered medically necessary and then with your plan provider to see if youll qualify for Medicare to cover it. Medicaid may offer coverage for some things Medicare may not, so keep that in mind if you have Medicaid as well.
Don’t Miss: Do You Have To Pay Medicare Part B
The Walker Must Be Deemed Medically Necessary
If you diagnose treatment, illness, injury, or any disease that requires you to use a walker, youre qualified to get a walker from your Medicare. In such cases, a walker is deemed medically necessary.
The term medically necessary refers to the situation when a doctor thinks that a piece of equipment can help diagnose or treat a health issue.
A qualified health care provider should do the assessment and suggest the rollator walker or standard walker as a medical necessity.
Does Medicare Cover Walkers & Canes
Posted by ALISON EMERICK
Youve been feeling a little weak or unsteady lately and have decided to do something about it before it becomes a problem. Or maybe your doctor, therapist or child took a look at you and said, Guess what? We are getting you a walker or cane. Before you guffaw and so NO WAY!, take a step back and give it some thought. If a walker or cane keeps you independent and safe, it is probably a good idea. If youve had surgery or an injury, you might not have a choice.
Will your cane or walker be covered by Medicare or insurance? It depends. And it is complicated.
What does Medicare cover and how to make the claim?
Medicare Plan B and Medicare Advantage Plans cover renting and purchase of walking aids like canes and walkers. But there are certain conditions to satisfy to receive coverage for the device.
First, you must produce a prescription for the walking aid from a doctor who participates in Medicare. The prescription should confirm that your mobility impairment prevents you from doing daily activities as you should. In other words, it should suggest that the equipment is medically necessary to help you move independently. It should also state that you will be able to use the equipment safely, without any danger of accident or injury.
You May Like: Which One Is Better Medicare Or Medicaid
Eligibility Requirements For A Walker Paid For By Medicare
There are three main eligibility requirements that must be met for Medicare to cover the cost of a walker:
1. The walker must be considered medically necessary
Your healthcare provider or must be satisfied that a walker is medically necessary to treat an illness, condition, injury, or disease that you suffer from.2. The walker must be prescribed by a doctorIn order for your walker to be covered by Medicare, it must be prescribed to you by a doctor.3. The doctor and the supplier must accept MedicareBoth the doctor and the walker supplier must accept Medicare in order for the walker to be covered.
How To Get A Walker For An Elderly Person Through Medicare
Your elderly aunt refused to use a cane when her arthritis began to affect her mobility, but after several falls, you’ve convinced her to get a walker. Medicare, the government’s healthcare program for the over-65 crowd, can help pay for her walker — if her condition meets certain criteria. In 2014, Medicare Part B provided 80 percent of the purchase or rental of such assistive devices when medically necessary.
You May Like: Does Medicare Cover International Medical Emergencies
Are Walkers For Seniors Medically Necessary
The term medically necessary refers to things a doctor prescribes because you need them to treat or diagnose a health issue.
- One National Institute of Health study found that 24 percent of people over 65 relied on at least one kind of mobility device. Devices included in the study included walkers, wheelchairs, and canes.
- Almost 10 percent of people over 65 used more than one kind of mobility device within the same time period. For instance, an elderly person might use a cane around the house but rely on a walker for longer trips.
Doctors might prescribe canes or wheelchairs for seniors with pain or balance problems to help them move around with a reduced risk of falling. Helping older patients remain somewhat active and decreasing their risk of injuring themselves in a fall could satisfy the requirements to establish medical necessity. Typically, the doctors prescription will have to include a description of the item that you need and exactly how it can improve your health or prevent a medical risk.
How Often Does Medicare Cover For A Walker
Typically, Medicare will replace any equipment that it covers, and which is worn out, once every five years from the date that it was received.
So, you can replace your walker with Medicare Part B every five years, unless it has been lost, stolen or damaged beyond repair.
Equipment which has been covered by Medicare which is lost, stolen or damaged beyond repair, may be replaced Medicare will of course require proof of the initial coverage, and purchase.
The passage is on Page 13 of the PDF. You can also download the document from the link above.
Don’t Miss: Is Medicare A Federal Program
Get Free Assistance With Understanding Medicare
SHIP State Health Insurance Assistance Programs
There is free guidance about Medicare, Medicaid and Medigap available from your SHIP over the phone, all you have to do is call.
I have a quick guide showing how to find your local SHIP, which you can find here Free Help Understanding Medicare And Medicaid ? Heres Where You Get It.
How Do I Get The Walker If It’s Covered
Once your doctor or health care practitioner determines your walker is medically necessary, they must fill out an order for Medicare. Medicare may also require your doctor to provide information and documentation regarding your need and necessity of the walker. The DME supplier your doctor works with will make sure they submit all required information. Once you qualify for coverage, you will purchase or rent your walker through the DME supplier.
Remember, only suppliers enrolled in Medicare are covered. To find one, visit Medicare.gov/supplierdirectory or call Medicare directly.
Recommended Reading: Can You Be Dropped From Medicare
Is The Upwalker Covered By Medicare
No, Medicare does not consider UPWalker for medical coverage.
The UpWalker is a walker that supports the users upper body while also allowing them to keep appropriate posture. It is generally sold as a cash-pay product, and the suppliers are not members of Medicare.
UPWalker is a great product for many people and is definitely worth the extra pay. It is built with high-quality and durability that is rarely found in other walkers.
You can get your UPWalker covered in many other ways, like with insurance or at a discount.
Iso Certification For Indoor/outdoor Use
Due in part to its unique design, the innovative UPWalker is the only upright walker to receive ISO 11199-3:2005 Certification for both indoor and outdoor use. This certification is awarded according to stringent tests for stability of walking aids with horizontal arm supports. Independent testing of impostures demonstrates a tip over risk.
Read Also: Does Medicare Cover Eye Exams For Glaucoma
Don’t Miss: Does Medicare Cover Toenail Removal
How A Supplement Plan Can Help
Medicare Supplement Plans help fill in the gaps in standard Medicare coverage . There are a variety of Medigap plans out there, each with their own advantages for different folks. That said, every Medigap plan covers at least 50% of the Medicare Part B coinsurance for walkers, with most Medigap plans covering 100% of the cost.
Medicare Supplement Plan G covers 100% of the Part B coinsurance. To You can view rates instantly online here.