If you have trouble walking and your doctor has prescribed a walking aid, Medicare will likely pay for part of the bill. Here’s an overview of what’s covered and how best to use the coverage available to you.
If You Have Original Medicare
Medicare Part B covers doctor-prescribed walking aids deemed medically necessary for use in your home.1 Walking aids may be prescribed temporarily, such as crutches, to help recover from a broken leg. They may also be prescribed for a permanent condition, such as a wheelchair for a patient with a spinal injury or advanced Multiple Sclerosis.
What Is Durable Medical Equipmen?
Walking aids fall under the category of durable medical equipment. They include crutches, canes, walkers, wheelchairs, scooters, and motorized wheelchairs.
To buy or rent durable medical equipment (DME), Medicare recipients must use a DME supplier. That company must have enrolled with Medicare and agreed to Medicare’s reimbursement rates. Your prescribing doctor must also have done the same. Your doctor can help you find a nearby supplier and determine if buying or renting makes sense.2
What Are Your Costs?
With Medicare Part B, you’ll be responsible for the 20% coinsurance and any Part B deductible that is still applicable before the coinsurance. (The Part B deductible for 2020 is $198.3) For equipment such as motorized scooters, pre-approval may be necessary. Some Medicare Supplement Insurance plans, also known as Medigap, will cover the deductible. Check with your Medigap insurer to find out if your policy offers this coverage. Once the deductible is met, any policy will pay the 20% coinsurance.
If You Have Medicare Advantage
If you purchased a Medicare Advantage plan, it must cover walking aids.
Check with your insurer to see how much out-of-pocket costs you’ll face when you rent or buy a walking aid. And be careful which supplier you use. Most Medicare Advantage plans require you to rent or purchase equipment through an in-network provider.
One final note on Medicare coverage: The durable medical equipment category is rife with Medicare fraud.4 Always make sure to have a doctor’s prescription and use a Medicare-approved supplier (or supplier approved by your Medicare Advantage plan) to avoid scams.
If You Have Private Insurance
Private insurers also offer coverage for prescribed walking aids. Depending on your plan, you may need an assessment from your healthcare provider.
Whenever a mobility aid is prescribed, call your insurer before buying to check how your coverage works.
You may also need to use a DME supplier that accepts your insurance. Keep in mind, however, that you can still be turned down for coverage if you don’t have the proper prescription or assessment.
As with Medicare, private insurers offer coverage under certain conditions. Mobility limitations must prohibit you from achieving daily activities, such as dressing or bathing. You must also be able to use the mobility aid safely.5