Does Medicare Cover Knee Walkers ?

by | Beginners Info, Health Care

Knee walkers, or knee scooters, are a very popular of way getting around if you have a lower leg injury. I have to say they might be a bit too hard for elderly adults like my 90 year old mom, to use, but nevertheless they are very popular, although not exactly cheap !

Does Medicare cover knee walkers ? No, Medicare Part B does not cover knee walkers, or knee scooters, as they are not considered “medically necessary”. You may find you can get coverage with Medicaid and other sources of state funding and financial assistance, if you are eligible. 

The knee walkers are for those who have just had an ankle/foot surgery, or an injury, as it allows you to completely take the weight off the ankle/foot.

Unfortunately, Medicare considers them to be more of a comfort item than “medically necessary”.

You can though, get walking boots, crutches, walkers and wheelchairs covered, as long as you follow the process correctly and you are really eligible.

Let’s take a look at what you have to do to get those through Medicare Part B for “use in the home”.  

Does Medicare cover transport chairs ?

Original Medicare Part B does cover transport wheelchairs when they are prescribed by a Medicare-enrolled doctor.

To qualify for a in-home transport wheelchair your treating doctor has to state that the transport wheelchair is “medically necessary”.

“Medicare’s Wheelchair and Scooter Benefit” -Revised October 2019, gives a full technical explanation of who qualifies and why.

You can read the it here. 

If you have a prescription from a Medicare-enrolled doctor, and you have used a Medicare-enrolled “Participating” supplier who accepts assignment (more about this later), you can expect Medicare Part B to pay 80% of the purchase, or rental, of the transport wheelchair, and you will have to cover your 20% co-payment and, if it applies, your deductible.

How often will Medicare pay for a wheelchair ?

The Medicare Part B policy for replacing covered DME, is to replace equipment which they cover that is –

  • worn out through use
  • that has been in your possession for it’s 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

Typically, a wheelchair which is worn out under Medicare Part B coverage can be replaced every five years, as long as it has always been in your possession.

For worn out items which have not reached the end of their lifetime, Medicare will pay to repair them – they will pay up to the cost of a replacement item.

Each time you replace an item after 5 years, or when it is worn out, you will have to go through the whole process with your Medicare-enrolled doctor of getting the prescription again. 

Will Medicare pay for  walker and a wheelchair ?

Medicare Part B will not cover more than one mobility aid for use in the home.

You either get a wheel chair, or a walker.

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, and if you have a wheelchair, a walker should be of no use to you, because you are not in condition to use a walker. 

Does Medicare cover shower chairs or any other bathroom equipment ?

Original Medicare B will not cover shower chairs for use in the home, as they are not “medically necessary”.

Medicare considers the shower chair to be a comfort item.

And unfortunately, they seem to feel the same way for much of the equipment in the bathroom.

None of the following items are covered –

  • bath seats
  • grab bars
  • floor to ceiling poles
  • bath lifts
  • shower chairs
  • bath chairs
  • raised toilet seats
  • transfer seats
  • toilet safety frames

Medicare does not consider any of these to be”medically necessary”.

There are some pieces of equipment which Medicare will cover that can be used for bathroom safety if you have problems standing –

  • walkers
  • crutches
  • bedside commodes

If theses item are  prescribed by a Medicare-enrolled doctor as “medically necessary” in accordance with medicare’s guidelines, they will typically be covered.

How does Medicare choose which equipment it will cover ?

“Durable Medical Equipment”, or DME, is the name given to medical equipment that Medicare Part B will cover “for use in the home”, if the beneficiary is eligible.

For an item to qualify as Durable Medical Equipment it must –

  • be able to withstand repeated use over a sustained period of time – durable
  • be used for a medical reason only – not for comfort
  • be of use to someone who is actually sick, and of little use to a person who is well
  • be primarily for use in the home
  • be expected to last at least 3 years

How do you get coverage from Medicare Part B for DME ?

To get coverage from Medicare Part B for DME for “use in the home” –

  • you have to be enrolled in Medicare Part B
  • have your Medicare-enrolled doctor give you a signed prescription which states that the equipment is a “medically necessary” according to the Medicare guidelines
  • you have to purchase or to rent the equipment through a Medicare-enrolled supplier

For Medicare coverage “living at home” is  defined as –

  • living in your own home
  • living in the family home
  • living in the community, such as assisted living 

What do you do with the signed prescription from your Medicare-enrolled doctor ?

Once you have your prescription you –

  • find a Medicare-enrolled DME supplier
  • make sure the supplier is a Medicare-enrolled “participating” supplier who accepts “assignment” – this ensures you pay no more than you have to
  • the equipment Medicare gives coverage to is the more basic models, but with certain equipment you may be able to upgrade, but you will pay the extra, and it isn’t always possible
  • choose the model of the equipment that you have been prescribed
  • complete all of the necessary paperwork with the supplier to comply with Medicare

As long as you have used a Medicare-enrolled supplier, with your prescription from a Medicare-enrolled doctor stating that your item is “medically necessary”, Medicare part B covers 80% of the Medicare-approved price for DME.

If you used a Medicare-enrolled “participating” supplier who accepts assignment, you will only have to pay your Medicare 20% co-payment of the Medicare-approved price for your DME, plus your deductible if it applies.

Do not purchase or rent from a Medicare-enrolled supplier who is not a Medicare-enrolled “Participating” supplier who accepts “assignment”, if not you may more than is necessary. Always confirm with the supplier !

 

Medicare may rent, or purchase, your DME – if your item is rented from the supplier, which is the case for most of the pricier equipment, you will still have the same payment structure, you will just pay a 20% co-payment of the monthly rental..

Finding a local Medicare-enrolled DME Supplier near you

You can use this link to find a Medicare-approved supplier who is local to you –  Medicare.gov

What if you have a Medicare Advantage Plan ? 

If you have a Medicare Advantage Plan you are covered for everything that Original Medicare Parts A and B cover.

You will have at least the same coverage for DME for “use in the home” as with Medicare Part B.

The process for assuring coverage and for then purchasing the DME will vary from provider to provider, as each plan will have its own network of doctors and suppliers that they will want you to use.

So always contact your plan provider before you get any equipment.

Durable Medical Equipment generally covered by Medicare if you qualify

If you don’t find the equipment you are looking for in my list of  Medicare covered DME below, you can use this link to Mediace.gov 

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.

Free one-on-one help with understanding Medicare

You can get free assistance at SHIP – State Health Insurance Assistance Programs.

SHIP – free state counseling services for people who need to talk to someone who’ll help them understand Medicare, Medicare Advantage, Medigap and Medicaid benefits.

Typically it’s a phone service, but there are programs which offer face-to-face appointments as well.

To connect with your local Medicare 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 – they both lead to the same menu to choose your state.

Step 3 –

Pick your state from the list and click on it.

Step 4 –

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

Does Medicaid cover knee walkers and other DME ?

Each state in the US has a lot of latitude in what it can do with Medicaid, due its funding – both federal and state sources –  as long as it keeps within the basic Medicaid guidelines.

In any state Medicaid may agree to waive some of the requirements for eligibility for different programs, allowing states to provide care to those who might otherwise slip through the system.

These are known as Waivers and have specific eligibility requirements, and may have limited places and waiting lists.

 

Care in the home – Medicare and state programs

 

Programs called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers” are exist to help individuals maintain their independence in their homes, and the community.

These are primarily for low income families, disabled individuals and the elderly.

To find out if you are eligible contact your State Medicaid Agency here.

Your local Area Agency on Aging should be able to help you find out as well.

To find out more on HCBS programs or waivers you can follow the link below to medicaid.gov –

https://www.medicaid.gov/medicaid/hcbs/authorities/index.html

The HCBS programs and waivers, and 1915 waivers will all cover “home medical equipment”, often up to 100% , to help the elderly and disabled to stay in their own homes.

The term “home”, for the beneficiary, is used to cover any of the following –

  • their own home
  • their family home
  • a group home
  • an assisted living facility
  • a custodial care facility

Programs and waivers which often have greater breadth in what they consider as DME for “in home use” 

HCBS programs and waivers with a type of budget management called either “Consumer Direction” or “Self Direction” 

The program participant is largely in charge of how the money is spent.

They are given a budget to cover their needs. The participant will also have the help of an appointed a financial advisor.

If, for the participant, being able to maintain their independence depends on them having certain equipment, as long as the budget covers it, they will very often get it – this can lead to a wider range of equipment being allowed as DME.

To find out more about Medicaid Self Direction click here.

Returning the elderly back into their homes from nursing home care

 

Money follows the person – this Medicaid program takes the elderly who are in care but who could, with help, live in their own home, and helps them to make that transition.

What is essential to the move, and to maintaining the elderly person’s independence in their home, is bought by the program.

It can be as much as remodeling parts of the home to make to make the move possible.

The range of DME’s is again wider than what is allowed on Medicare.

If your income is just too high for Medicaid eligibility

Certain states have a program called Spend Down.

Spend-Down helps to reduce a person’s income level so that they may qualify for Medicaid, HCBS’s and waivers.

One method is to subtract the person’s medical bills from their income, and subsequently if their income level falls below the  limit for eligibility, the person will be deemed eligible to apply for assistance.

You can read a lot more in this article on the US NEWS website here.

How to get DME with Medicaid and state waivers and HBSC programs ?

Step 1

– the doctor, or therapist, has to provide a medical justification letter, stating it is medically necessary

Step 2

–  find a Medicaid-approved DME supplier , and give them the medical justification letter

Step 3

– the Medicaid-approved supplier fills out a Prior Approval Application form for Medicaid

Step 4

– the Prior Approval Application is sent to the Medicaid State Office

Step 5

– if you are unsuccessful you will be contacted  and given the reasons as to why, as well as advice on how to make an appeal

Step 6

– if approved, you will receive the DME

Find the HCBS programs, waivers and 1915 waivers with their eligibility criteria in your state

To find what is on offer in your state click here.

Step 1 –

Pick your state from the map.

Step 2

Click on you state 

Step 3 –

Choose –

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

You will then see a page like this example below, with the programs and waivers in your state, and their eligibility criteria.

To find your State Medicaid State Agency

If you just want to talk to, or to email someone, contact you state Medicaid Agency here.

Step 1 –

Click the link to Medicade.gov, look to the section I outlined in red.

Step 2 –

Select your state and click on the button they have marked “GO” – it will take you to your State Medicaid Agency with all their contact info.

State Funding Assistance

Assistive Technology Programs

All states have Assistive Technology Programs to increase access to assistive devices in the home – the primary focus is on the elderly and the disabled.

Assistive Technology devices covers equipment which makes it possible for a person to complete tasks they otherwise cannot – from bathroom safety equipment through to electronic digital devices.

To find out what programs are in your state click here.

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 Project state website will come up, and you can sign up, or use their contact info .

State Financial Assistance Programs

A number states have non-Medicaid programs which help the elderly to remain living in their homes.

Paying for safety items, assistive equipment, the programs will also cover the costs of remodeling bathrooms, wheelchair ramps, kitchen.

The programs primarily focus on the elderly and the disabled, and pay with grants, give loans or do a combination of both.

Find out about these from your local Area Agency on Aging.

    Summary

    You cannot get a knee walker, or knee scooter, with Medicare Part B for use in the home.

    You can though, get coverage  for crutches, walkers, rollators, and walking boots, if they are “medically necessary”, and you a have a signed prescription from a Medicare-enrolled doctor.

    Medicare will typically cover 80% of the Medicare-approved price of any equipment they cover.

    Always ask the supplier if they are a Medicare-enrolled “Participating” Supplier who accepts “assignment”.

    Medicaid and state programs in many cases accept a broader range of equipment as DME, and will often pay 100% of the cost.

    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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    Article Name
    Does Medicare cover knee walkers ?
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    No, Medicare Part B does not cover knee walkers, or knee scooters, as they are not considered "medically necessary". You may find you can get coverage with Medicaid and other sources of state funding and financial assistance, if you are eligible. 
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    Lookingaftermomandad.com