Does Medicare cover walking canes ?
I would think the cane is possibly the easiest, and most the commonly used aid by both the elderly, and anyone has had issues with their legs and ankles. Now, although they are not usually what I would call expensive, why pay the full whack if you have insurance ?
Does Medicare cover walking canes ? Walking canes are covered by Original Medicare, as long as you have the prescription from a Medicare-enrolled physician which states that it is medically necessary. If Medicare does not cover one in your particular case, it may be possible to get one through Medicaid, or other sources.
There are three things that you have to take into account to understand if an item qualifies for coverage by Medicare –
Firstly, is your item for which you want coverage in the category of equipment covered by Medicare – Durable Medical Equipment ?
Secondly, is the item “medically necessary” in your case ? – only a Medicare-enrolled doctor can decide this, and he will strictly follow Medicare’s guidelines on this.
Thirdly, you of course have to be enrolled in Original Medicare.
Here are Medicare’s guidelines to determining if a person is eligible for a cane, or crutches, so you can get the idea.
The information is taken from CMS.gov (Center for Medicare and Medicaid Services) and can be found here.
“1.The beneficiary has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) in the home.
The MRADLs to be considered in this and all other statements in this policy are toileting, feeding, dressing, grooming, and bathing performed in customary locations in the home.
A mobility limitation is one that:
a.Prevents the beneficiary from accomplishing the MRADL entirely, or,
b.Places the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform an MRADL; or,
c.Prevents the beneficiary from completing the MRADL within a reasonable time frame;
2.The beneficiary is able to safely use the cane or crutch; and,
3.The functional mobility deficit can be sufficiently resolved by use of a cane or crutch.
If all of the criteria are not met, the cane or crutch will be denied as not reasonable and necessary.”
Does Medicare cover walkers, and which ones ?
Walkers are very much one of the commonly used pieces of equipment by the elderly and a very necessary to many.
My Mom has used one ever since her hip replacement as her balance is sometimes a little off.
At 90 Mom can be rather stiff when she gets up at night, and the frame by the bed just helps her to have something to hold onto as she straightens up into a standing position.
Walkers come in quite a few varieties, from one without wheels to rollators.
All of these are covered by Medicare as long as you get a prescription form a Medicare-enrolled physician saying that it is medically necessary.
Walkers just like the “walking boot” are part of what Medicare calls Durable Medical Equipment or DME’s – a little more about that later though.
How often does Medicare cover for a walker ?
Typically, Medicare will replace any equipment that it covers, and which is worn out, once every five years from the date that it was received.
So you can replace your walker with Medicare Part B every five years, unless it has been lost, stolen or damaged beyond repair.
Equipment which has been covered by Medicare which is lost, stolen or damaged beyond repair, may be replaced – Medicare will of course require proof of the initial coverage and purchase with them.
Source: Medicare coverage of Durable Medical Equipment and Other Devices, CENTERS for MEDICARE & MEDICAID SERVICES. You can read the whole document here.
The passage is on Page 13 of the pdf. You can also download the document from the link above.
Does Medicare Part B cover walking boots ?
Walking boots, or ankle-foot orthosis, are orthopedic devices used for the stabilization of the foot and ankle used for broken bones, severe sprains, tendon and ligament tears, surgeries and orthopedic conditions.
As I said, Medicare Part B will cover “walking boots” under the benefit for Orthotics or Braces, but there certain conditions to this and they will only cover them if –
- the “walking boot” is rigid or semi rigid
- the walking boots are being used to immobilize the ankle/foot following orthopedic surgery or for an orthopedic condition
As long as you have a prescription from a Medicare-enrolled physician which states that it is medically necessary, you will typically be covered.
If the walking boots are being used to relieve pressure, especially on the sole of the foot, or are for foot ulcers, the walking boot is not covered. Medicare has coverage for Therapeutic shoes for those with diabetes.
Does Medicare cover Knee walkers ?
Despite the popularity of knee walkers, or knee scooters, as they are also commonly called, these items are not covered by Medicare.
The knee walkers are a popular piece of equipment for those who have just had an ankle surgery and as it allows you to completely take the weight off the ankle, but Medicare considers it to be more of a comfort item and it doesn’t fill there criteria for being covered due to this.
I guess Medicare feels a pair of crutches will do the job just as well !
If you don’t have any kind of other insurance to cover one, it is still a lot cheaper to rent one as compared to buying one.
How does Medicare define, and decide which equipment it will cover ?
Medicare uses the term “Durable Medical Equipment”, or DME’s, for medical equipment that it covers “for use in the home”.
I have compiled a long list of items that Medicare classifies as Durable Medical Equipment and which is typically covered for the home. You can jump on ahead to it if you click here.
For an item to qualify as Durable Medical Equipment it has to be seen to fulfill the following criteria –
- the item must be able to withstand repeated use over a sustained period of time – durable
- the item must be used for a medical reason only – not for comfort
- it is an item that is of use to someone who is actually sick, and of little use to a person who is well
- it is an item which is primarily for use in the home
- the item must be expected to last at least 3 years
How do you qualify for Medicare covered DME’s ?
To find a local Medicare supplier check this link at Medicare.gov
For you or a loved one to qualify for DME’s “for use in . the home” with Medicare coverage, 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” by the Medicare criteria
- have to acquire the equipment through a Medicare enrolled “participating” 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
With regards to nursing homes and hospitals, they are covered under Medicare Part A – hospital treatment . As such they cannot qualify as a home for Medicare Part B.
The coverage for DME’s is different for skilled nursing facilities, and they are provided for for up to 100 days by the nursing facility itself.
How do you, or your loved one, proceed once you have the signed prescription for your DME ?
Once you have you order/prescription it’s time for you or your loved one to go to a Medicare-enrolled DME supplier, and to choose your walking cane.
The range of cane which Medicare covers will be a somewhat limited one, as they only cover the most basic models of each type of equipment.
You will also have to fill out more forms with the supplier to prove you have the coverage and for them to get paid by Medicare. As long as you have the prescription from a Medicare-enrolled doctor, then Medicare part B will cover 80% of the Medicare-approved price for the walking cane with the Medicare enrolled-supplier
It is left for you ar your loved one to pay the Medicare 20% co-payment of the Medicare-approved price of the walking cane, as long as you used a Medicare-enrolled “participating” supplier who accepts assignment.
If you didn’t, you may owe more ! I will elaborate in a moment !
You or your loved one will also need to pay your Medicare deductible, if it hasn’t already been met for the year in question.
Medicare may purchase or rent DME’s
Typically, Medicare rents equipment from their DME Medicare-enrolled suppliers on a monthly basis, except for the least important items.
As long as the DME is rented from a Medicare-enrolled “participating” supplier who accepts assignment there is only a monthly co-payment of 20% of the Medicare-approved rental price, and of course the deductible if it has not been met.
How to get the best possible coverage and not over-pay ?
To get the best coverage for your DME with Medicare you must follow all the steps of the process correctly.
It is vital that you use a Medicare enrolled “participating” supplier who accepts “assignment” if you are to avoid paying any surplus.
This ensures the DME is bought at the Medicare-approved price, and that the 20% co-payment and your deductible are all you will pay.
So, what are you risking if you or your loved one get it wrong ?
There are two types of Medicare approved suppliers –
- Medicare Suppliers
- Medicare “Participating” Suppliers
Medicare “Participating” Suppliers, have an arrangement with Medicare whereby the Medicare “Participating” Suppliers will accept what is called “assignment” which means that they cannot charge more than the Medicare-approved price for DME’s.
Suppliers who are not “Participating” can charge what they like for equipment. Medicare will only pay the Medicare-approved price, which leaves you, or your loved one, to make up the shortfall, as well as the co-payment and annual deductible (if it applies).
The shortfall can be whatever extra amount the supplier has decided to charge above the Medicare -approved price for your item.
What do Medicare Advantage Plans cover in all of this?
If you have a Medicare Advantage Plan you are covered for everything that Medicare Parts A and B cover, and often a little more.
As regards the process you will need to contact your provider, as they will have their rules, and also their own network of doctors and DME suppliers whom you must use if you are to be covered.
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’s below, you can use this link to Mediace.gov
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 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
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.
DME’s usually 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
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-appointments as well.
To find local Medicare SHIP click on this link here
How to contact a SHIP counselor in your state step by step
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 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 walking canes and other DME ?
Medicaid does not work in the same way with its funding as Medicare – Medicaid is funded both on a federal level and at individual state level.
Each state, as long as it keeps within the basic Medicare guideline, can have a lot of latitude in what it can do with the different funding.
A state can have multiple programs, both state and Medicaid, for working with people in their homes and in the community, trying to help to maintain their independence.
What is considered Durable Medical Equipment will very widely , not only from state to state, but also on differing programs and waivers within the different states.
Medicaid and state programs for care services in the home
The programs which are designed to help individuals maintain their independence in their homes, and in the community, are called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”.
These programs are primarily for low income families, disabled individuals and the elderly.
To find out if you or your loved one are eligible, you will contact your State Medicaid Office.
Your local Area Agencies on Aging should be able to help you find out as well.
To get more technical information on the HCBS programs or waivers you can follow the link below to medicaid.gov –
The programs and waivers will pay for “home medical equipment”, and will often cover 100% of the cost in order to help the elderly, disabled and low income families in their homes.
The term “home”, for the beneficiary can cover any of the following situations –
- their own home
- their family home
- a group home
- an assisted living facility
- a custodial care facility
Certain programs and waivers may have greater breadth in what they are willing to consider as DME’s for home use
HCBS programs and waivers can sometimes operate a system “Consumer Direction”or “Self Direction”
With Consumer Direction or Self Direction , the program participant is given a budget to spend across all their needs. To help them manage this budget they are appointed a financial advisor.
The advisor is going to help the person manage the money to cover what they need to maintain their independence in their home.
Should the participant need certain medical equipment, and it falls within their allotted budget, and it is really vital to their being able to sustain their independence, then they will very often be allowed this equipment.
This equipment can extend to all sorts of bathroom safety equipment and other devices not available on Medicare as a DME.
To find out more about Medicaid Self Direction click here
Returning the elderly back into their homes
Money follows the person – is a Medicaid based program whose primary objective is to help elderly adults make the transition from nursing facilities back into their own homes – in this case assisted living can be considered as their own home.
Medical equipment which is necessary for the participant to be able to make the move, is purchased by the program.
What may be considered a DME here, can be very different from that which is allowed with Medicare, and can go as far as remodeling parts of the home to make things safer or simply possible.
If you don’t quite qualify for Medicaid
Some states have a program called Spend Down.
Spend-Down is a program which helps you to reduce your income level so that you can qualify for Medicaid benefits and HCBS’s and waivers.
One method is to allow you to subtract your medical expenses from your income, and if subsequently you fall below the Medicaid income limit, you will be eligible to receive Medicaid benefits.
What I have written here is grossly simplified, but you can read more in this article on the US NEWS website here.
How do you get DME’s with Medicaid waivers and HBSC programs ?
– the doctor, or therapist, has to provide a medical justification letter, which states that the equipment is medically necessary
– you or your loved one have to find a DME supplier who is Medicaid-approved, and to give to them the medical justification letter
– the DME supplier then fills out a Prior Approval Application for Medicaid
– the document is then sent to the Medicaid State Office for approval or denial
– if you or your loved one are unsuccessful you will be notified as to the reasons why, and given advice on how to appeal the decision
– if approved you or your loved one will receive the DME
Find the HCBS programs, waivers and 1915 waivers in your state
The link below will take you to CMS.gov. to look at the different “HCBS programs”, “waivers” and “1915 waivers” offered by your state and Medicaid.
Select your state on the map and it will show you a section with 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
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.
You can get walking canes and other aids such as crutches, walkers, rollators, and walking boots covered by Original Medicare Part for use in the home, as long as they are “medically necessary”.
So you don’t pay any more than your co-pay and your deductible, you really have to follow the right procedure.
Don’t forget, before purchasing the durable medical equipment, to ask the supplier if they are a Participating Supplier who accepts “assignment”.
Medicare will always buy the most basic version of any item of durable medical equipment, and will make the buyer pay for any upgrades if they are allowed on that item.
Medicaid and state programs in many cases accept a broader range of equipment as DME and will often pay 100% of the cost, if you are eligible.
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