As a caregiver for your loved one, like myself, or as the organizer of their care in the home, you’ll be sorting out all the equipment your loved one needs, and finding out how in the world they will pay for it all.
Original Medicare Part B will typically give 80% cover to crutches as long as they are “medically necessary” and prescribed by a Medicare-enrolled doctor. If Medicare doesn’t cover DME’s that you need, you may find coverage with Medicaid, or with other state funding sources.
Contents Overview & Quicklinks
How do you get crutches with Medicare coverage ?
To get the crutches for home use covered by Medicare, you will need to –
- be enrolled in Medicare Part B
- have a prescription/order signed by their Medicare-enrolled doctor, or treating practitioner, stating it is a medical necessity to have the crutches
- be purchasing the crutches from a Medicare-enrolled supplier
If the Doctor, treating practitioner, or DME suppliers are not Medicare-enrolled, Medicare will not cover any part of the purchase at all.
If you are claiming crutches for their “home”, a hospital or nursing home which is providing their care does not qualify for coverage under Medicare Part B. They will instead qualify under Medicare Part A.
A long-term care facility, such as an assisted living, can qualify as “home” for coverage under Medicare Part B.
The following are considered living at “home” by Medicare –
- you can be in your own home
- you can be living in the family home
- you can be living in the community, such as assisted living
How often can you get crutches with Medicare ?
Medicare will replace an item which has been worn out if you have had it in your possession for its whole lifetime.
For equipment replacement, the lifetime of a DME is never less than 5 years. You must have worn the equipment out from use to replace it.
When medicare replaces a piece of equipment, it is like-for-like. You can’t get the equipment upgraded when you are replacing it.
What if a DME is damaged or stolen?
If any DME covered by Medicare is lost, stolen, or damaged beyond repair in an accident or a natural disaster, Medicare will pay to replace it, as long as you have proof of the damage or theft.
Does Blue Cross Blue Shield cover crutches ?
There is no definitive answer for this question, as there are so many Blue Cross Blue Shield companies across all the states, but it would be surprising if a policy did not.
If you have a Blue Cross Blue Shield Advantage Plan, you will be covered for crutches, so long as you fill the Medicare conditions for coverage, and the crutches are medically necessary.
If you have any other kind of Blue Cross Blue Shield plan, other than a Medicare Advantage Plan, you can just call your insurer and give them the codes for your policy –
- the CPT Code (your doctor will have given you a diagnosis code)
- the HCPC Code (that is the code for the crutches you have been prescribed)
With the codes, your insurer can tell you if you are covered, or not.
You will still need a prescription from your physician stating that the crutches are medically necessary.
Does Aetna cover crutches ?
Yes, Aetna does cover crutches under certain conditions.
You can read the policy criteria here – http://www.aetna.com/cpb/medical/data/500_599/0505.html
Does Cigna cover crutches ?
Yes, Cigna does cover crutches under certain conditions.
You can read the policy criteria here – https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0050_coveragepositioncriteria_ambulatory_devices.pdf
Does Medicare cover wheelchairs ?
Medicare Part B covers wheelchairs and power-operated vehicles for use in the home when a Medicare-enrolled physician –
“submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home.”
The information above comes from the Medicare Wheelchair and Scooter Benefit PDF.
What are the Medicare qualification criteria for a standard wheelchair ?
Medicare Part B basic criteria for a standard wheelchair is –
Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters), walkers, and wheelchairs as durable medical equipment (DME). Medicare helps cover DME if:
• The doctor treating your condition submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home.
• You have limited mobility and meet all of these conditions:
– You have a health condition that causes significant difficulty moving around in your home.
– You’re unable to do activities of daily living (like bathing, dressing, getting in or out of a bed or chair, or using the bathroom) even with the help of a cane, crutch, or walker.
– You’re able to safely operate and get on and off the wheelchair or scooter, or have someone with you who is always available to help you safely use the device.
– Your doctor who is treating you for the condition that requires a wheelchair or scooter and your supplier are both enrolled in Medicare.
– You can use the equipment within your home (for example, it’s not too big to fit through doorways in your home or blocked by floor surfaces or things in its path).
Will Medicare pay for a walker and a wheelchair ?
Medicare will not cover more than one mobility aid for use in the home, so if you have an electric, or manual, wheelchair you cannot get a walker as well.
As far as I could understand this point, the reasoning is that if you can use a walker, you don’t need a wheelchair, and so you fail their rule of medical necessity for the wheelchair.
How often will Medicare pay for a wheelchair ?
The Medicare Part B coverage policy for replacing DME, is to replace equipment that you rent or own that is –
- worn out through use
- that has been in your possession for its entire lifetime
- the item must be so worn out that it can’t be fixed
- the minimum period considered to be a lifetime for an item is five years
- the lifetime varies on the type of equipment
That said, a wheelchair which is worn out under Medicare Part B coverage can be replaced every five years if it has always been in your possession – and that is if it is beyond repair.
Medicare will pay to repair worn items which have not reached the end of their lifetime – they will pay up to the cost of a replacement item.
In the case of a worn out item, you will need to get your Medicare-enrolled doctor to re-prescribe the wheelchair, and again say why it is “medically necessary”.
What equipment will Medicare pay for ?
Medicare Part B has will cover certain durable medical equipment for use in the home if it is “medically necessary”.
Durable medical equipment, or DME, is medical equipment which can withstand constant repeated use over a sustained period of time within the home.
Medicare’s criteria for DME –
- the equipment must be “durable” and able to withstand repeated use over an extended period of time
- the individual must be using for the equipment for a medical reason, and not just because it gives some comfort
- the equipment is not usually useful to a person who is not sick or injured
- the equipment is for use in the home – you can use it outside, but if you don’t need it inside, it doesn’t qualify
- the equipment is expected to have a lifetime of at least 3 years
If the equipment doesn’t meet these criteria, it is unlikely to qualify for Medicare coverage.
Original Medicare Part B covers, with a prescription from a Medicare-enrolled physician, equipment like crutches, walkers, and wheelchairs, as it considers them “medically necessary”, but it won’t cover items such grab bars, as these are considered to be “comfort items”.
Be warned that Medicare will typically only agree to the coverage of the cheapest version of the durable equipment that your loved one needs, and if you want anything more elaborate, you will have to pay for the upgrade yourself.
Medicare’s defines “Durable Medical Equipment” in its literature as “ reusable medical
Do Medicare Advantage plans cover crutches ?
If you have a Medicare Advantage Plus plan (often called Medicare Part C) you should be able to get crutches covered by their plan, but will have to check with your provider.
Medicare Advantage Plans, which are run by Medicare-approved private companies, are bound by law to provide, as a minimum, the same Medicare services and coverage as Original Medicare Parts A and B.
Again, check with your provider when you get your crutches, as they will have their own requirements for the claim.
One of those requirements is, very likely, to be that you have to buy the equipment from a supplier in their network, otherwise you risk footing the bill yourself.
Medicare-approved equipment supplier near me
To locate a Medicare supplier in your area you can use this link on Medicare.gov
List of durable medical equipment typically covered by Medicare
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
Bed Side Rails
Bed Trapeze – covered if your loved one is confined to their bed and needs one to change position
Blood sugar monitors
Blood sugar (glucose) test strips
Canes (however, white canes for the blind aren’t covered)
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Cushion Lift Power Seat
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Infusion pumps and supplies (when necessary to administer certain drugs)
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mobile Geriatric Chair
Nebulizers and some nebulizer medications (if reasonable and necessary)
Oxygen equipment and accessories
Patient lifts (a medical device used to lift you from a bed or wheelchair)
Postural Drainage Boards
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Urinals (autoclavable hospital type)
Whirlpool Bath Equipment – if your loved one is home bound and the pool is medically needed. If your loved one isn’t home bound, Medicare will cover the cost of treatments in a hospital.
Prosthetic and Orthotic Items
Orthopedic shoes only when they’re a necessary part of a leg brace
Arm, leg, back, and neck braces (orthotics), as long as you go to a supplier that’s enrolled in Medicare
Artificial limbs and eyes
Breast prostheses (including a surgical bra) after a mastectomy
Ostomy bags and certain related supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.
Cataract glasses (for Aphakia or absence of the lens of the eye)
Conventional glasses or contact lenses after surgery with insertion of an intraocular lens
Important: Only standard frames are covered. Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare, no matter who submits the claim (you or your supplier).
If you don’t use a Medicare-enrolled “participating” supplier, your loved one may end up paying far more for their purchase.
List of durable medical equipment typically not covered by Medicare
Augmentative Communication Device
Bed Exit Alarms
Bed Sensor Pads
Beds – Lounge
Blood Glucose Analyzers
Braille Teaching Texts
Caregiver Paging Systems
Catheters – except those which are used for permanent medical conditions where the catheter is considered as a prosthetic
Chair Exit Alarms
Chair Sensor Pads
Contact Lenses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens
Disposable Bed Protectors
Door Exit Alarms
Electrical Wound Stimulation
Exit Alarm Mat
Eye Glasses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens.
Heat and Massage Foam Cushion Pad
Heating and Cooling Plants
Humidifiers – not room humidifiers
Injectors (hypodermic jet pressure powered devices for Insulin injection)
Motion Sensor Exit Systems with Pagers
Over bed Tables
Paraffin Bath Units (if not Portable)
Portable Room Heaters
Portable Whirlpool Pumps
Preset Portable Oxygen Units
Pull String Alarms
Raised Toilet Seats
Special TV Close Caption
Speech Teaching Machines
Surgical Face Masks
Telephone Alert Systems
Television Assistive Listening Devices
Walk in Bathtubs
What happens now you have a prescription ?
Once your doctor, or treating practitioner has filled out the order/prescription, you have taken the prescription to a supplier, and you and the supplier have done all the necessary paperwork, you will get the equipment.
If you used a Medicare-enrolled doctor, and the supplier is a Medicare-enrolled “participating” supplier who accepts “assignment”, then –
- your deductible for Medicare part B will apply
- you will pay the supplier the co-pay of 20% of the Medicare approved price of the equipment
- Original Medicare Part b will pay the supplier the remaining 80% of the Medicare-approved price
In the case of cheaper items, Medicare will usually purchase the items, rather than renting them.
Why should you use a Medicare-enrolled “Participating” supplier ?
If you don’t use a Medicare-enrolled “participating” supplier, you may end up paying far more for their purchase.
And why is that the case ? –
Firstly, you must use a Medicare-enrolled supplier, as they have accepted to take payment from Medicare, and have also passed all of Medicare’s required standards of service.
But it’s more than just that…
There are two groups of Medicare-enrolled suppliers –
- Medicare Suppliers
- Medicare “Participating” Suppliers
Medicare “Participating” Suppliers have agreed to accept what is being called “assignment” – a supplier who accepts “assignment” can only charge the Medicare-approved price.
- the “participating” supplier will submit the claim for the equipment to Medicare
- once the equipment claim has been approved by Medicare, the “participating” supplier can only charge the 20% co-pay of the Medicare-approved price
- if your annual Medicare deductible applies, they will have to pay this as well
If you are not using a “Participating” Supplier ?
A supplier who is a Medicare-enrolled supplier, but who is not a “Participating” Supplier –
- has agreed to take the Medicare-approved price payment for the DME from Medicare
- but can sell the DME to you at the price of their choice – or at least for up to 20% percent more
The result being –
- as agreed, Medicare will pay the supplier their 80% of the Medicare-approved price for the DME
- you will end up paying their 20% co-pay of the Medicare-approved price + the difference in price between the Medicare-approved price and the supplier’s own price, to the supplier
- And you will also have to pay their annual Medicare deductible if it applies
So do make sure you are using a Medicare-enrolled “Participating” Supplier, and always ask if the supplier accepts “assignment”.
What if your loved one is in a skilled nursing facility ?
If you are being treated in a Skilled Nursing Facility or hospital, any necessary medical equipment is covered by Medicare Part A (Hospital Insurance). The facility is required to provide any DME needed for 100 days.
Free assistance with understanding Medicare
SHIP – State Health Insurance Assistance Programs –
Free counseling about Medicare, Medicaid and Medigap is available from your state program.
If you want to find your SHIP and get more information about it, I have a short article explaining that here – “Free Help Understanding Medicare And Medicaid ? Here’s Where You Get It”.
Does Medicaid cover crutches ?
Medicaid does not work with its funding in the same way as Medicare.
The funding for Medicaid is both federal and state funding.
A state can have multiple Medicaid programs, Home Community Based Services Waivers, each with their own eligibility criteria and goals, resulting in hundreds of programs and waivers for Medicaid across the US.
Each state also contributes funds to the programs, and what is considered to be durable medical equipment, can vary from program to program, let alone from state to state.
Medicaid and state programs for “in the home”
Medicaid and state programs which are for home care, are called “Home and Community Based Services”, “Waivers” or “1915 Waivers”.
The prime purpose of HCBS programs and waivers is to help the beneficiaries to be able to maintain their independence in their own home, by providing the support in terms of care and services to do this.
These programs and waivers will also pay for “home medical equipment”, and often cover 100% of the equipment cost.
To find out more in depth, and technical information, you can follow this link to Medicaid.gov – https://www.medicaid.gov/medicaid/hcbs/authorities/index.html
What is considered a DME will vary the most on the state funded waivers and programs, which have the greatest breadth of equipment that may include within the category.
On HCBS programs and waivers, the term “home” is used to mean that the beneficiary should be living in –
- a person’s own home
- a person’s family home
- a group home
- an assisted living facility
- a custodial care facility
Consumer Direction and Self Direction
To empower the beneficiaries of the different HCBS programs and waivers, and to help take even more control of their lives, systems of Consumer Direction or Self Direction were developed.
The system is set up so that the beneficiary receives their allotted funding for their living needs, which they spend under the guidance of a financial planner. Durable medical equipment is amongst the items they can purchase, should they need to.
Such items as a bathtub, a grab bar, a bath lift, or shower chair, not considered durable medical equipment by Medicare, may well be purchased if they are a “medical necessity” and are within the allotted budget.
If you would like to find out more about Medicaid Self Direction, click on this link here.
Money Follows the Person
The next type of program we are going to look at is designed to help people who are transitioning from state nursing facilities back to their home.
The program is called Money follows the person, please note that the term home can include assisted living.
The Durable medical equipment which is necessary for the persons to return to their homes and live there in safety is bought by the program.
Once again, what qualifies as a DME, such as a range of safety equipment, is broader than that allowed under Medicare.
Here’s how to check the HCBS programs, waivers and 1915 waivers in your state
To check the HCBS Waivers, 1915 Waivers, HCBS Programs and the Money Follows The Person Programs for seniors which are available in your state, you can go to my article with a list of what is available in each state, as well as the links to take you to the appropriate program websites. Also listed are all the PACE programs which are for All-inclusive care in the home – “Medicaid Home and Community Based Services Waivers and Programs For Seniors Listed By State”.
How do you purchase DME on Medicaid and state funded programs and waivers ?
The process of purchasing a DME –
- you need to get your doctor, or therapist, to write a medical justification letter, stating the equipment is medically necessary
- give the medical justification letter from the doctor, or therapist, to a Medicaid-approved DME supplier
- the Medicaid-approved supplier will then fill out a Prior Approval Application
- the Prior Approval document is subsequently sent to the Medicaid state office where it will be approved or refused
- if the claim is not successful, Medicaid will notify you as to why, and on how you can appeal the decision
- if Medicaid and the program agree to the purchase of the equipment, the supplier will have it delivered to you
If your income is a bit too high to qualify for Medicaid
Spend Down Programs
Spend Down programs work to reduce a program participant’s income level, or income + asset level, so that they may qualify for Medicaid coverage, by allowing the deduction of certain expenses.
The two methods are called –
- Income Spend Down
- Asset Spend Down
Income Spend Down is the simpler of the two methods, and basically allows a participant to deduct certain medical expenses from their income.
I’ve written a short post about how it works, which you can find here – What is Spend Down ?
To find your State Medicaid State Agency
If you are finding the information at the site too wordy, I would contact your state Medicaid Agency, which you can do that here.
Step 1 – Once you have clicked the link to Medicaid.gov, just look over to the right on the website page, and you will see the section I have outlined in the image below.
Step 2 – select your state and click on the button they have marked “GO” – it will take you to your State Medicaid Agency, and you will be able to get all the contact info and make calls or send emails to get all the help you need.
Other funding sources for the elderly
Here are a couple of other sources of funding available to the elderly for medical equipment.
State Financial Assistance Programs
These are non-Medicaid programs, which exist to lower the number of elderly persons entering Medicaid run nursing homes.
The programs run on a state-by-state basis and are designed to help the elderly to remain living in their homes – not all states have them.
The programs will pay for home modifications and also purchase necessary equipment, which includes bathroom safety equipment and walk in tubs and showers.
Eligibility for the programs differs with each one, but generally they are for the elderly and the disabled.
There are quite a number of ways for the elderly to get free durable medical equipment, and with a little searching it is possible to find items.
Do be aware though that if you use some of the online services available, most of these are not going to guarantee the quality of the equipment, unless they say that they have refurbished it, and that it is safe.
Typically, there will be a disclaimer accepting no responsibility for any accidents which may arise from the use of the free item.
Here’s a list of the places that you can find free durable medical equipment –
- State Assistive Technology Programs
- Community Medical Equipment Loan Closets
- Craigslist – online listing near you
- UsedHME.com – Used Home medical equipment
- Nextdoor.com – an online listing of free items in your neighborhood
- Facebook Groups and Facebook Marketplace listings of items in your area which are offered for free
Free crutches on Assistive Technology Programs
A national grant is given to all states to be used in “Assistive Technology Programs”. The “programs” are meant to increase access to assistive devices in the home for those who need them.
The elderly are one of the primary groups who are meant to benefit from these projects.
The terms “Assistive Technology” and “DME” are pretty much interchangeable, and it covers all manner of equipment which can help in the home, so bathroom safety equipment is part of this.
Elderly adults are often able to obtain free, or very cheap Durable Medical Equipment and Assistive Technology Devices from their state AT Programs.
State AT programs tend, in general, to work with nonprofit organizations and charities, to provide new, and refurbished equipment to those in need.
So and take a look at your state Assistive Technology Program
Finding your state AT Program
To find out what projects your state runs, click here.
Select your state from the map or from the drop-down menu.
Then click on “Go to state”
– I chose Florida for this example
Look “Program Title” and click on it – In this example I outlined it in red.
This takes you to your state AT Program website where you can sign up, or use their contact info to get in touch and find out what they offer to help the elderly.
Free crutches from Medical Equipment Loan Closets
Many towns and cities have medical equipment loan closets run by community volunteers, where seniors can borrow, and even be given DME for free.
The equipment available depends on the group of course, but you can find anything from hospital beds to walkers, and usually all for free.
Free crutches on Craigslist
You can use the online classified listing website Craigslist to find durable medical equipment that private individuals are offering for free.
What is helpful about this listing is the ease with which you can do a local search. You can restrict it to your town, or even to a neighborhood in a larger city.
There is a section in the sales listing, which is “free stuff”, and you just select that and look through it.
Free crutches on UsedHME.com
This is a website which is specifically for those who wish to sell, buy or donate used home medical equipment.
You can just go on the site, set up how far you are willing to travel from your home, and then search for free equipment within that area.
Once you have found an item, you will be able to get the contact details of the person offering the equipment, and organize with them how you will pick it up.
Free crutches from Freecycle.org
This is an organization of groups of people all over the world who offer used items for free.
You can search for groups in your area on their website, and then look through what is available.
If you see things which interest you, you ask to join the relevant group, and then contact the person offering the item you are interested in.
Everything is free.
Free crutches from Nextdoor.com
This is a site of neighborhood groups where you can buy, sell, donate and get items for free.
You can join your neighborhood and search for items of durable medical equipment which are being given away.
Free crutches on Facebook Selling Groups and Marketplace
Facebook has a lot of what are called “selling groups” where people buy and sell products. You can often find items which are being offered for free – I actually saw a hospital bed being offered for free last year on one group.
You are able to join groups if you have a Facebook account.
You then select the distance from your home within which you want to search. Facebook will then give you a list of the groups, and you can join the ones you want to.
You will then see postings of all the items in the groups, and which are offered for free.
You can also join Facebook Marketplace, which is separate from groups and is a platform where people on Facebook can buy and sell items, but also donate and get for free.
You just need to browse Marketplace to see what there is.
Marketplace is often not available when you first join Facebook, and you may have to wait a few months for it to appear in your Facebook dashboard, but the selling groups are available to join straight away.
Where to ask about free crutches in your neighborhood
You could try some of the following locations in your neighborhood –
- Your local Area Agency on Aging
- Lions Clubs
- Rotary Clubs
- Local church communities
Area Agencies on Aging
Area Agencies on Aging are nonprofit agencies appointed by the state to provide services to help adults over the age of 60, their families and their caregivers to find the information, assistance and services that they need in the community – the ultimate goal is to help the elderly to maintain their independence and to remain living in their own homes.
Your local Area Agency on Aging is an excellent place to start asking questions on who may know where to find free medical equipment, where there may be loan closets for DME, or if you want, cheap thrift stores selling gently used equipment.
The National Association of Area Agencies on Aging has a locator tool to help you find an agency near you, which can be found here.
The Lions run some community loan closets for home medical equipment for seniors.
You can find a club near you, and ask if they have, or know of, any loan closets in your area.
I have written an illustrated guide showing how to very quickly find a Lions Club near you, and you can find that here.
Just like the Lions organization, Rotary Clubs do a huge amount of charity work, and run many programs through the organization’s clubs.
Si if you are having trouble finding loan closets in your area, it may be a good idea to locate a club near you and ask if they know of clubs, or other organizations, in your area that have free medical equipment loan closets.
You can use their club locator tool to find a club near you.
I have written another illustrated guide on locating a Rotary Club near you, that you can read here – it’s a very quick and easy read.
You can get crutches and other walking aids such as canes, walkers and rollators covered up to 80% for use in the home by Original Medicare Part B.
But you do have to follow the right procedure for it to be as cheap as possible.
Don’t forget, when arranging your loved one’s durable medical equipment, to make sure that you ask the supplier if they are a Participating Supplier who accepts “assignment”.
Medicare will typically buy the least expensive of the version of any item of durable medical equipment, and will make the beneficiary pay for any possible upgrades.
Medicaid has a less restricted idea of what can be considered “medically necessary” on certain programs and what can qualify as a DME.
I’m Gareth, the author and owner of Looking After Mom and Dad.com
I have been a caregiver for over 10 yrs and share all my tips here.