Do you have a medical condition that requires you to use a walker?
Read on to find out whether Medicare covers walkers, your Medicare eligibility, your coverage options, and other medicare supplement insurance plans.
1. Does Federal Medicare Program Cover Walkers?
Yes, Medicare covers walkers under Medicare Part B insurance. Part B medical insurance falls under Original Medicare. It’s also included in the Medicare Advantage plan.
Therefore, as long as you have Part B, Medicare will pay for your walker and other selected durable medical equipment.
How Do I Qualify For Part B?
Let’s see how The Centers for Medicare & Medicaid Services (CMS) determines eligibility for Part B.
CMS uses eligibility for Part A to determine whether you qualify for Part B.
The Social Security Administration (SSA) enrolls you in the federal Medicare program for options A and B when:
- you turn 65 years
- and you begin receiving Social Security or Railroad Retirement Board benefits.
Key differences to note:
- Retirees automatically qualify for Medicare Part A. Non-retirees must apply to get Part A.
- For retirees, Part A is a free hospital insurance plan. Non-retirees have to pay a premium to access Part A.
- For both retirees and non-retirees, Part B attracts a monthly premium.
You can decline enrollment for Part B or terminate your enrollment at any time.
I’m Not A Retiree. Do I Still Qualify For Part B?
If you’re not a retiree, you’re not eligible for premium-free Part A. And so, you must meet some more requirements to qualify for Part B.
- You must be 65 years or older
- You must be living in the U.S. as a citizen or alien who’s been a permanent resident for 5 years
If you meet the above requirements, you can apply for Part B insurance. Then you’ll have access to walkers covered by Medicare.
I’m A Retiree But Don’t Have Plan B. Can I Join Now?
Perhaps you were once enrolled in Medicare, but you terminated your membership. If this describes you, you can re-enroll in the program.
But you can only do so between January 1 and March 31 when the General Enrollment Period opens.
Similarly, you may have declined Part B, even though you were eligible for it. In this case, you can also enroll during the enrollment period.
But there’s a price to pay: CMS charges a late enrollment penalty. You will have to pay this penalty for the duration you stay enrolled in Part B.
You may have failed to enroll when you first became eligible because:
- you had group health insurance with another insurance company
- or you were serving as an international volunteer outside the country.
Medicare offers Special Enrollment Periods (SEPs) for both cases.
The Terms & Conditions for SEP registration are different from General Enrollment Period terms.
For example, SEP sign-ups do not attract a late registration penalty.
2. How Much Does Medicare Pay For A Walker?
Medicare covers 80% of DME costs and walkers fall under this category.
So your Part B cover will pay 80% of the cost of your walker. Then you will pay the remaining 20% as coinsurance.
Coinsurance means you’re sharing the cost of insurance with the insurance provider. In our case here, as the insurance provider, Medicare settles 80% of the cost, and you clear the difference.
Note that you still have to pay your Part B deductible as well as Part B premium.
Your Part B Deductible
For Medicare to cover the payment for your walker, you must fulfill your yearly deductible.
The Part B deductible is different each year. CMS usually releases the set amount for the deductible a couple of months before the start of the new year.
You have to fulfill your deductible before Medicare can step in and pay for mobility aids such as a walker.
The deductible applies when you receive Medicare-covered healthcare services. So Medicare credits your deductible to each bill it receives from your doctor until the dollar amount is fulfilled.
Say the bill for your first doctor’s visit in 2022 comes to $150. Medicare subtracts this amount from your deductible.
The 2022 Part B deductible is $233.
$233 minus $150 leaves you with $83.
So you must spend $83 more before Medicare chips in and covers your medical costs. That means on your second visit to a healthcare provider, Medicare will apply the $83 to your bill.
If the bill is higher than $83, you’ll have fulfilled your deductible. Medicare will then pay 80% of the difference, and you’ll cover the remaining 20%.
So if your second bill comes to $500, you’ll first deduct $83, which is your deductible.
You now have a balance of $417.
Medicare will settle 80% of $417, which comes to $333.60.
And you will settle 20% of $417, which is $83.40.
Your Part B Premium
CMS sets a standard premium for Part B each year, so the premium amount varies from year to year. But not everyone pays this set amount.
Some people pay more.
The exact amount you pay in premiums depends on your Modified Adjusted Gross Income (MAGI). CMS relies on the reported MAGI on your IRS tax return to calculate your premium.
If your MAGI exceeds a given amount, CMS adds an Income-Related Monthly Adjustment Amount (IRMAA) to the standard Part B premium. So you pay a higher premium amount.
If your MAGI is below a given amount, you pay the standard Part B premium amount.
For 2022, for example, the standard premium amount for Part B is $170.10. So you’ll give $170.10 to Medicare every month throughout 2022.
Beneficiaries of Social Security, RRB, and Office of Personnel Management (OPM) don’t send premiums to Medicare. Instead, Medicare deducts the premium from their benefit payment.
If you do not receive benefits from any Federal agency, CMS bills you for the premium. They typically send the bill one month in advance.
You can pay your Part B premium with funds from:
- your savings or checking account
- a debit or credit card
- via check or money order. You can mail these to the Medicare Premium Collection Center.
3. Are There Requirements To Be Met For Medicare To Cover My Walker?
Yes, Medicares offers the service under strict standards. Three things should happen before your walker can be covered by Medicare.
A. The walker is considered medically necessary.
Your healthcare provider determines the necessity of the durable medical equipment, DME, in this case the walker. Then Medicare confirms this determination using documentation from your health care provider.
B. Medicare Pay For Walkers Applies To Prescribed Orders Only
Medicare will not pay for a walker because you deem that you need one. It pays only when there’s a doctor’s prescription for the walker.
C. Your healthcare and DME providers should be Medicare-enrolled providers.
Medicare covers walkers only when the request comes from a Medicare-approved provider.
Providers who opt out of the service do not accept Medicare as a form of payment. And Medicare does not make payments to providers who are Medicare-enrolled.
D. Both the doctor and DME supplier must accept assignment.
Your doctor and walker supplier have to accept assignment for Medicare to settle your doctor’s claim for a walker. That means they approve the payment amount Medicare sets.
Some Medicare-enrolled providers choose not to participate in Medicare. That means they do not accept the governing rules and payment terms that Medicare issues.
You can still get your walker from non-participating providers. However, they will likely charge you more than what Medicare approves for the service. That means you’ll pay more than what you would pay under Medicare coverage.
Medicare can pay the standard 80% of the medicare-approved amount. But you have to settle the extra charges the provider bills you.
Non-participating providers can choose to accept Medicare assignments on a case-by-case basis.
Is your doctor a non-participating Medicare provider?
Ask them if they will accept Medicare assignments.
If they say yes, then Medicare will pay 80% for your walker, and you clear the remaining 20%.
Accepting assignment means the provider accepts to be paid by Medicare.
It further means the provider accepts the payment amount approved by Medicare. This amount is usually lower than what the provider typically charges.
Lastly, the provider agrees to bill you for the deductible and coinsurance only.
Most providers bill you after Medicare pays its share. But even if they bill you before Medicare pays, they will only bill you for 20% coinsurance and deductible.
4. My Walker Is Old. Will Medicare Pay For A New One?
Yes, Medicare plans take care of the repair and replacement of DME.
But under one condition:
You must be the only person to have owned the walker throughout its lifetime.
That means your Medicare plan will not cover pre-owned walkers. If you recently bought a used walker that needs repair, Medicare won’t pay for those repairs. You have to find another way to finance the repair cost.
But if the walker was new when you bought it, Medicare will cater for the cost of repairing or replacing it.
Medicare will cover repair costs if your walker is damaged due to:
- regular wear
- defective parts
Where To Get Repair Services For Your Walker
Your DME supplier may not offer repair services. And that’s okay.
Medicare does not ask suppliers who sell DME equipment to be responsible for its repair.
If the Medicare-approved supplier from whom you bought the walker offers repair services, you may go to them for repair work.
But if they don’t do repair work, you can choose a repairman from Medicare’s approved list of suppliers.
Medicare Walker Replacement Coverage
Medicare pays for a replacement walker when the walker is:
- damaged beyond repair due to a natural disaster or emergency
- unusable due to wear
- older than 5 years
5. Should I Rent Or Buy A Walker?
Buying a walker is cheaper than renting, especially if you’ll be using the walker for a long time.
The monthly cost of renting the walker will quickly add up and surpass the cost of a new walker.
Medicare usually buys walkers and rollators. So they will not have a problem paying for your new walker.
Generally, CMS reserves leasing for some expensive equipment. But there may be instances where it makes more sense to rent than buy.
Say you only need the walker for a few weeks. You can opt to rent it, in which case Medicare will settle the rental fee.
Your DME supplier is responsible for any repairs your rented walker may need.
Medicare limits the amount they pay in rental payments. They only pay amounts equal to what they spend on new walkers.
So the service can only cover rented walkers up to a certain amount. If rental costs exceed what Medicare pays for new walkers, Medicare won’t pay the excess.
Further, Medicare decides how long they’ll pay the rental fee.
Consider these rules when choosing between buying and renting a walker.
6. I’m Moving To A Care Facility. Will Medicare Pay For My Walker?
It depends on the type of care facility into which you’re moving. Medicare only pays for DME expenses that you incur when living in some types of care facilities.
Medicare Durable Medical Equipment Coverage In A Long-Term Care Facility
Medicare may pay for your walker if you’re staying in a long-term care facility. This only happens if the facility does not offer Medicare-covered services.
Remember: Medicare pays for DME items that healthcare providers prescribe for everyday use at home. And a long-term care facility is similar to a home environment because it’s not a 100% hospital setting.
Your doctor can confirm whether you’ll be eligible for DME coverage if you move into the facility.
You can also find out by talking to a Medicare representative online or through the phone. Medicare has phone lines for regular callers and TTY users, so reaching them is easy.
Medicare DME Coverage In Skilled Nursing Facilities and Hospitals
Medicare does not pay for DME when you’re in a hospital, nursing home, or skilled nursing facility (SNF).
Hospitals, nursing homes, and SNFs offer Medicare-covered care.
So they should provide you with the mobility devices you need during your stay at the facility.
Key Takeaways: Does Medicare cover walkers?
Medicare cover walkers are available for anyone with Part B insurance.
If you’re 65 years or older and don’t have Medicare Part B, you can enroll in the plan. It’s the gateway to accessing DME coverage.
Medicare pays for the repair, replacement, and purchase of new DME. That includes walkers and rollators.