Does Medicare Cover Crutches ?

by | Beginners Info, Health Care

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.

What type of equipment does Medicare cover ?

Medicare has will cover equipment for use in the home, or a skilled nursing facility, if it falls within its category of “durable medical equipment” or DME’s.

You can jump ahead to a full list of Durable Medical Equipment covered by Medicare  here.

Medicare’s criteria for DME’s

  • 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 Parts A and B cover, with a prescription, 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 yourselves.

Medicare’s defines “Durable Medical Equipment” in it’s literature as “ reusable medical equipment like, walkers, wheelchairs, or hospital beds”

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.

To locate a Medicare supplier in your area try this link to Medicare.gov

This is Medicare’s documentation on DME’s at Medicare.gov 

How does my loved one get their crutches with Medicare coverage ?

To get the crutches for home use covered by Medicare your loved one will need to –

  • be enrolled in Medicare Part B
  • have a prescription/order signed 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 loved one is 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

What happens now your loved one has a prescription ?

Once your loved one’s doctor, or treating practitioner has filled out the order/prescription, your loved one has taken the prescription to a supplier, and your loved one and the supplier have done all the necessary paperwork, your loved one will get the equipment.

If your loved one used a Medicare-enrolled doctor, and the supplier is a Medicare-enrolled “participating” supplier who accepts “assignment”, then –

  • your loved one’s deductible for Medicare part B will apply
  • your loved one will pay the supplier their 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.

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Why should my loved one use a Medicare-enrolled “Participating” supplier ? 

If you don’t use a Medicare-enrolled “participating” supplier, your loved one 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 are have agreed to  accept what is being called “assignment” – a supplier who accepts “assignment” can only charge the Medicare-approved price.

So

  • 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 loved one’s annual Medicare deductible applies they will have to pay this as well

If your loved one is not using a “Participating” Supplier ?

A supplier who is 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 your loved one 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
  • your loved one 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 your parent will also have to pay their annual Medicare deductible if it applies

So do make sure your loved one is 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 your loved one, is 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.

Can you get crutches if you have Medicare Advantage ?

If your loved one has a Medicare Advantage Plus plan (often called Medicare Part C) they should be able to get crutches covered by their plan, but will have to check with their 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 loved one’s provider when your loved one gets their 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. 

Durable medical equipment which is typically covered by Medicare

To qualify your loved one will need to have Original Medicare Parts A and B.

  • Part A (Hospital Insurance) is for beneficiaries who are living in skilled nursing facilities
  • Part B (Medical Insurance) covers  living at “home” – I outlined the definition of “home” here

Air-Fluidized Bed
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
Bead Bed
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)
Commode chairs
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Crutches
Cushion Lift Power Seat
Defibrillators
Diabetic Strips
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Heat Lamps
Hospital beds
Hydraulic Lift
Infusion pumps and supplies (when necessary to administer certain drugs)
IPPB Machines
Iron Lung
Lymphedema Pumps
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mattress
Medical Oxygen
Mobile Geriatric Chair
Motorized Wheelchairs
Muscle Stimulators
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)
Oxygen Tents
Patient Lifts
Percussors
Postural Drainage Boards
Quad-Canes
Respirators
Rolling Chairs
Safety Roller
Seat Lift
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Sitz Bath
Steam Packs
Suction pumps
Traction equipment
Ultraviolet Cabinet
Urinals (autoclavable hospital type)
Vaporizers
Ventilators
Walkers
Whirlpool Bath Equipment – if your loved one is homebound and the pool is medically needed. If your loved one isn’t homebound 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
Urological supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.

Corrective Lenses

Prosthetic Lenses
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
Intraocular lenses

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).

DME’s typically not covered by Medicare

Adult Diapers
Air Cleaners
Air Conditioners
Alcohol Swabs
Augmentative Communication Device
Bathroom Aids
Bathtub Lifts
Bathtub Seats
Bed Bath
Bed Boards
Bed Exit Alarms
Bed Sensor Pads
Bed Lifter
Beds – Lounge
Bed Wedges
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
Communicator
Contact Lenses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens
Dehumidifiers
Dentures
Diathermy Machines
Disposable Bed Protectors
Disposable Sheets
Door Exit Alarms
Easygrip Scissors
Elastic Stockings
Electrical Wound Stimulation
Electrostatic Machines
Elevators
Emesis Basins 
Esophageal Dilators
Exercise Machines
Exit Alarm Mat
Eye Glasses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens.
Fall Alarms
Fans
Fabric Supports
Fomentation Device
Grab Bars
Grabbers
Gauze
Hearing Aids
Heat and Massage Foam Cushion Pad
Heating and Cooling Plants
Home Modifications
Humidifiers – not room humidifiers
Incontinence Pads
Injectors (hypodermic jet pressure powered devices for Insulin injection)
Irrigating Kits
Insulin Pens
Massage Equipment
Motion Sensors
Motion Sensor Exit Systems with Pagers
Needles
Oscillating Beds
Over bed Tables
Paraffin Bath Units (if not Portable)
Parallel Bars
Portable Room Heaters
Portable Whirlpool Pumps
Preset Portable Oxygen Units
Pressure Leotards
Pressure Stockings
Pulse Tachometer
Pull String Alarms
Raised Toilet Seats
Ramps
Reading Machines
Reflectance Colorimeters
Sauna Baths
Special TV Close Caption
Speech Teaching Machines
Stair Lifts
Standing Table
Support Hose
Surgical Face Masks
Surgical Leggings
Syringes
Telephone Alert Systems
Television Assistive Listening Devices
Telephone Arms
Toilet Seats
Treadmill Exercisers
Walk in Bathtubs
Wheelchair Lifts
Whirlpool Pumps
White Canes
Wigs

Free assistance with understanding Medicare

SHIP – State Health Insurance Assistance Programs –

Each state in the US has a SHIP which offers free guidance and advice on Medicare.

You need to use the link below to contact you SHIP, and you can get help with any questions you may have about Medicare over the phone.

SHIP also give advice on Medicare Advantage, Medigap and Medicaid benefits.

To get in touch with your local SHIP click on this link  here.

How to contact a SHIP counselor in your state, step by step

Step 1 –

After you have clicked on the link you will arrive here –

Step 2 –

Click on one of the two buttons to find your state 

Step 3 –

Pick your state and click on it.

Step 4 –

A window will open with the contact info and a phone number for you to call in your state.

Does Medicaid cover crutches and other DME ?

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 included 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.

What if your revenue is too high to qualify for Medicaid ?

The Spend Down Program

Simply put, Spend-Down programs reduce a person’s income level so that they may become eligible for Medicaid, HCBS’s and waivers.

The simplest method by which this is achieved, is to subtract a person’s medical expenses from their income, and if as a result their income level falls below the Medicare eligibility limit, the person will then qualify.

Unfortunately, not that many states have a Spend-Down program, but if yours does it may be just what you need.

Do check with your Area Agency on Aging, as some states have a similar program but under a different name.

 US NEWS has an article which covers the topic here.

How does your loved one 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 be 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

Here’s how to check the HCBS programs, waivers and 1915 waivers in your state

Follow the link below to CMS.gov. to have a look at the different “HCBS programs”, “waivers” and “1915 waivers” offered by your state.

Select your state on the map and a list will appear showing your state waivers and programs, as well as their eligibility criteria – click here.

Step 1 – Find your state on the map.

Step 2 – Click on you state – I chose N.Dakota as an example

Step 3 – You will come to your state and it’s resources, and here you can choose

 

  • your state Medicaid Agency which I marked with a (1), or
  • your Home and Community Based Services, Waivers and 1915 Waivers which I marked with a (2)

Below is an example of the type of page you will get if you click on the HCBS programs and waivers link.

You will be able to find out what programs and waivers there are in your state, and what the eligibility criteria are.

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, and you can do that here.

Step 1 – Once you have clicked the link to Medicade.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 0r do emails to get all the help you need.

State Funding Assistance

Assistive Technology Programs

The US government gives each state a federal grant which is called a State Assistive Technology Grant, with which they are to design and build a State Assistive Technology Program.

These AT Programs have been developed to improve access to assistive devices in the home primarily for the elderly and the disabled.

State Assistive Technology Programs typically have  –

  • an online equipment exchange for state residents to register and participate in the posting and exchanging, selling and buying of used equipment and AT devices
  • a main program website which coordinates the services and explains the project to users
  • reuse, recycling and refurbishment programs which are run by the state project, sometimes partnering with non-profits, to provide free or extremely low cost equipment for those in need
  • states usually run loan closets as part of their program, where either long term or short term loans of equipment and devices can be made

Assistive Technology Programs will register people who need help, and subsequently contact them when specific equipment becomes available.

You can find out more on your State Assistive Technology Program website.

To see what projects are in your state click here

Follow the steps below to see the projects in your state

 

Step 1/

Pick your state on the map or the drop down menu, and click on “Go to state”

– I chose Florida for this example

Step 2/

Click on the link “Program Title” – for my example I outlined it in red.

Step 3/

The AT Program state website will come up, and you can register, or use their contact info .

State Financial Assistance Programs

There are some non-Medicaid programs to help the elderly and the disabled to to maintain their independence at home – this is financial assistance.

State Financial Assistance Programs have quite a lot of scope and will pay for simple assistive devices, safety equipment, durable medical equipment, as well as home modifications – even remodeling bathrooms and kitchens.

The programs’ members may receive grants or loans, or both with which to realize what needs to be done.

To see if you have a State Financial Assistance Program in your state just check with your local Area Agency on Aging, and they should be able to advise you on programs for the elderly, and if there is one in your state.

Summary

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 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 and I’m the owner of Looking After Mom and Dad.com

I have been a caregiver for over 10 yrs and share all my tips here.

Gareth Williams

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Does Medicare cover crutches ?
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Yes, Original Medicare Part B will cover 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 other state funding sources.
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