Will Medicare Pay For Walkers?

Medicare will cover the cost of a walker if it is deemed medically necessary by your doctor, and you can show that you require more support than a cane or crutches can provide in order to be mobile. To ensure that Medicare pays for the walker, you must follow the steps below:

• Only your doctor can prescribe the equipment for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you.
• The doctor must document the need in your medical records that supports the medical necessity of the walker 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 through one of the Medicare Advantage Plans (like an HMO or PPO) it is likely you will have to follow the plan’s steps for approval and purchase. Make a point of calling your plan’s customer service number and ask about what they require for coverage of a medical walker.

Part B Medical Coverage And Walkers

How much you pay will depend on whether or not you have Part B coverage and where you buy your equipment. However 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 will pay less if you buy from a supplier who accepts assignment. A supplier who accepts assignment has agreed to accept the Medicare payment as full payment and will not ask for more than your 20% deductible.
• You may owe little to nothing if you receive your health care through a Medicare Advantage Plan, depending on the plan with which you have signed up 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 equipment through an approved supplier that accepts assignment.

Saving Money on Your Walker

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 walker from any store that sells them. However, if the supplier from which you order your walker 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.
• A Medicare-approved supplier who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15% above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the walker. In this situation Medicare will send the reimbursement directly to you. However, 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 equipment purchases. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know 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 Medicare Advantage Plan's customer service and ask about your coverage before you order your walker.

When Does Medicare Pay For Medical Walkers?

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 walker must meet Medicare's test of durability. Medicare will pay for medical equipment when:

• It will be used repeatedly; for example a walker that is used to help you move around your home.
• It has a medical purpose; for example it replaces, supports or steadies a body part (like legs) as you move about and you need more support than a cane or crutches can provide.
• 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).
• The primary use will be inside the home. Although you can also use the walker while outside the home, it may not be for use only when outside the home setting.

Different Types/Styles of Medical Walkers

Walkers come in a variety of styles and sizes, each style and size has been designed to meet a specific medical need. When you order your walker, the suppler will fit the walker for your height and the type of shoes you will wear when using the walker. The type of walker Medicare will approve for you will depend on your medical needs. Basically, walkers fall into two categories:

• Standard Folding Walkers - These are the no-frills models. All models fold, making them easy to get in and out of the car or store away in a closet.
• Rollators - These models come in both three and four-wheeled models. In addition to locking hand brakes and baskets, some rollator walker models come with seats. Rollator models also have hand brakes or pressure brakes. To qualify for pressure brakes you must show that you do not have the hand strength to operate the hand brakes.

Walkers over and above the standard folding walker are covered for people who are unable to use a standard walker due to size (weight over 250 pounds), severe neuralgic disorders, or restricted use of one or both hands.

It is important to note that Medicare will not pay for equipment that cannot be justified by your medical condition. The information that qualifies you for the equipment you order must be stated on the prescription. Medicare will always base their payment on the least costly alternative.