Does Medicare Cover Crutches?

Yes, Medicare will cover crutches if they are deemed medically necessary.  They will be considered necessary if you need additional support when you walk or the crutches will be taking the place of a missing limb. However, you must follow the steps below to ensure that Medicare pays for the equipment:

Only your doctor can prescribe the equipment for you, so do not order anything until you have visited your doctor, no matter what a sales person tells you.

The doctor must document the need in your medical records supporting the medical necessity of the crutches, and give you a signed and dated order (prescription) for the equipment.
The order must be received by the supplier before Medicare is billed and it must be kept on file by the supplier.

If you receive your Medicare coverage through a Medicare Advantage Plan (like an HMO or PPO) it is likely that the plan has its own restrictions, so you should follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage.

How Do I Qualify for the Coverage for Crutches?

If you have been admitted to a hospital or a Skilled Nursing Facility (SNF), they will provide any special equipment you may need. However, for coverage outside of those settings, you must have Medicare Part B coverage and your doctor must have documented your need for the equipment and written you an order (prescription) for the equipment. In addition, the crutches must meet Medicare's test of durability. Medicare will pay for medical equipment when:

• It will be used repeatedly; for example, crutches that are used to help you move around your home.
• It has a medical purpose; for example, they replace, support or steady a body part (like legs) as you move about.
• It would not be useful if you were not ill or had an injury.
• The primary reason for needing the item is to help you move about independently, not to prevent an injury from occurring where no injury or illness exists (even though it will help prevent injury as well).

If Covered, Where Do I Get The Crutches?

You will save money if you order your item from a Medicare-approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your crutches from any store that sells them. However, if the supplier from which you order your crutches is not enrolled in Medicare, Medicare will not pay for the equipment. Things you should think about before you choose a supplier:

• There are two types of Medicare suppliers: participating suppliers, and those who are enrolled but have chosen not to participate.
• Participating suppliers must accept assignment, which means they agree to charge only the Medicare-approved amount. A Medicare-approved provider who does not want to participate can charge more than the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the crutches. In this situation, Medicare will send the reimbursement directly to you, but be prepared to wait; it may take a couple of months to receive payment.
• If you receive your Medicare coverage through a Medicare Advantage Plan (like an HMO or PPO) it is likely that the plan will have its own steps for purchasing crutches. In addition, the plan may have restrictions on what suppliers you can use. It is important to know, however, that your health plan must supply at least what Medicare covers -- they cannot supply less. Depending on your plan, you may actually receive more coverage than you would get with Medicare alone. It is wise to call your plan's customer service and ask about your coverage before you order your crutches.

What Will It Cost For Crutches?

How much you pay will depend on whether you have Part B coverage, have a Medigap/Medicare Supplemental policy or coverage through a Medicare Advantage Health Plan (like an HMO or PPO), and who you buy your equipment from. In general, if you are enrolled in Medicare Part B:

You will pay 20% of the approved Medicare amount, after you have paid your yearly deductible.

You may save money if you purchase your crutches from a Medicare Supplier who accepts assignment. A supplier who accepts assignment has agreed to charge no more than the Medicare approved amount for the crutches.

You may owe little to nothing if you receive your Medicare through a Medicare Advantage Health Plan or have a Medigap/Medicare Supplemental Policy, depending on the plan you have signed up for and your benefits with the plan.

It is important to do your homework. Read about the factors that affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you buy your crutches thought an approved supplier. For more information, call 1-800-MEDICARE (1-800-633-4227), 24 hours, 7 days a week, including some federal holidays.  TTY/TDD users can call 1-877-486-2048. However, the interactive phone system is available 24 hours every day of the year.