Does Medicare Pay for a Walker? A Complete Guide

Does Medicare Pay for a Walker? A Complete Guide

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December 30, 2023

As we age, maintaining mobility becomes a crucial aspect of daily life. For many seniors, walkers serve as invaluable aids, providing support and stability. Mobility aids, such as walkers or canes, are a more portable and realistic option that reduces fall risk and enhances independence. If you’ve started to use a walker, or if your doctor has mentioned the benefits of a walker to you, you might be researching different types as well as the financial implications of purchasing one.

If you’re a Medicare beneficiary, you might also wonder: Does Medicare cover the cost of walkers?

The short answer is, yes, Medicare will cover most types of walkers, provided they are deemed “medically necessary.”  There are certain steps you’ll need to follow to ensure coverage.

Types of Walkers

In this article, we’ll explore the intricacies of Medicare coverage for walkers, including the requirements, types of walkers covered, financial considerations, and steps to ensure coverage.

What Are the Requirements To Be Covered?

Medicare coverage for walkers is not a one-size-fits-all scenario. Medicare.gov outlines specific criteria that individuals must meet to qualify for coverage. Generally, Medicare Part B covers durable medical equipment (DME), like walkers, when prescribed by a doctor for use in the home.

To be eligible for coverage, you must meet the following criteria:

  1. Medical Necessity: Your doctor must deem the walker medically necessary for you to perform daily activities within your home. Your prescribing physician must also be Medicare-enrolled.
  2. Face-to-Face Examination: A face-to-face examination by your doctor is required, during which they will evaluate your mobility and determine the necessity of a walker. Virtual appointments or phone-in consultations will typically not warrant the prescribed walker being covered by Medicare Part B.
  3. Written Prescription: Your doctor must provide a written prescription for the walker, specifying the type and features required.
  4. Supplier Accreditation: Ensure that the supplier from whom you purchase or rent the walker is Medicare-approved. Medicare typically covers equipment obtained from suppliers enrolled in the Medicare program.

What Types of Walkers are Covered?

woman standing with walker smiling and looking out of the window

Medicare covers various types of walkers to meet the diverse needs of beneficiaries. It’s important to note, though, that not all walkers meet the needs of everyone. Your provider will prescribe the type that will best suit your needs. The covered types include:

  1. Standard Walker: A basic walker with four legs and no wheels, providing stable support.
  2. Two-Wheeled Walker: Similar to a standard walker but equipped with two wheels on the front legs, making it easier to move.
  3. Rollator: A walker with four wheels, handlebars, and a built-in seat for resting. Some rollators also have brakes for added safety.
  4. Knee Walker: Designed for individuals with lower leg injuries, a knee walker allows the user to rest the injured leg on a padded cushion while propelling themselves with the other leg.
  5. Hemi Walker: Ideal for users who need more support on one side of their body, a hemi walker has a design that offers support on only one side.

It’s essential to discuss with your doctor which type of walker best suits your needs before obtaining one.

Ready to learn more about the different types of walkers? Read our helpful guide on the Best Walkers for Seniors.

How Much Will Medicare Pay for a Walker?

The amount Medicare pays for a walker depends on various factors, including the type of walker and whether you rent or buy it.

Grandpa with adult son and young grandson walking

Generally, Medicare covers 80% of the cost of a walker, and you are responsible for the remaining 20%. However, this coverage is subject to your Part B deductible. Currently, the annual deductible set for 2024 is $240.

The cost of walkers can vary widely, so it’s crucial to choose an option that meets both your medical needs and your budget. If you have additional coverage through a Medigap (Medicare Supplement Insurance) plan or a Medicare Advantage plan, some or all of the remaining costs might be covered.

Steps to Getting a Walker Covered by Medicare:

  1. Visit Your Doctor: Schedule a visit with your doctor to discuss your mobility needs. Your doctor will evaluate your condition and determine whether a walker is medically necessary. Ensure your physician of choice is Medicare-enrolled. You can ask if they are when you make the appointment.
  2. Get a Written Prescription: If your doctor determines that a walker is necessary, they will provide you with a written prescription detailing the type of walker and any specific features required.
  3. Choose a Medicare-Approved Supplier: Before obtaining a walker, ensure that the supplier is enrolled in the Medicare program. Medicare generally covers durable medical equipment acquired from approved suppliers. If needed, your physician can provide you with DME retailers that are Medicare-enrolled.
  4. Submit the Prescription to the Supplier: Provide the written prescription to the Medicare-approved supplier. They will verify your eligibility and submit a claim to Medicare on your behalf.
  5. Pay Your Share: Once Medicare processes the claim, you will be responsible for your share of the costs, including the 20% coinsurance and any applicable deductible.

What If I’ve Already Bought a Walker?

In some instances, individuals may purchase a walker before realizing that Medicare coverage is available. If you find yourself in this situation, you may still be eligible for reimbursement. Remember, if you purchased a walker that is not the type your physician prescribed, you might not be able to receive reimbursement at all.

To seek reimbursement, follow these steps:

  1. Gather Documentation: Collect all relevant documentation, including the written prescription from your doctor, the receipt for the walker, and any other supporting documents.
  2. Complete a Medicare Claim Form: Obtain and complete a Medicare Claim Form (CMS-1490S). You can download this form from the official Medicare website or request it from your Medicare Administrative Contractor (MAC).
  3. Submit the Claim Form: Mail the completed claim form along with all supporting documentation to your MAC. Be sure to keep copies for your records.
  4. Wait for Processing: Once your claim is submitted, Medicare will process it, and if approved, you will receive reimbursement for the eligible amount.

What If I Need to Replace My Walker?

If your walker becomes damaged, lost, or you need to upgrade to a different type, Medicare may cover a replacement.

However, certain conditions must be met:

  1. Medical Necessity: Your doctor must confirm the medical necessity of a replacement walker.
  2. Face-to-Face Examination: An additional face-to-face examination with your doctor may be required to assess your current mobility needs.
  3. New Written Prescription: Obtain a new written prescription specifying the need for a replacement walker.
  4. Follow the Same Steps: Follow the same steps outlined earlier for getting a walker covered by Medicare, including choosing a Medicare-approved supplier and submitting the necessary documentation.

It’s important to note that Medicare may not cover a replacement walker if the need for a new one arises primarily due to wear and tear. The medical necessity must be clearly established.

Conclusion

Medicare does cover the cost of walkers for eligible beneficiaries, provided the necessary requirements are met. Understanding the criteria, types of walkers covered, and the financial aspects of Medicare coverage for walkers is essential for seniors seeking to maintain their mobility and independence.

By following the outlined steps and working closely with healthcare professionals, beneficiaries can navigate the process of obtaining and, if needed, replacing walkers with the support of Medicare.

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