Need a Walker or Wheelchair? Medicare Can Help

Need a Walker or Wheelchair? Medicare Can Help

If a sudden medical condition or gradual deterioration of your abilities has made walking on your own impossible, it’s important to understand if you’re eligible for equipment that could provide you with therapeutic benefits. Whether you have Original Medicare or a Medicare Advantage Plan, your Medicare Part B coverage can help cover the costs of your Durable Medical Equipment (DME) and allow you to focus on what is really important – maintaining your mobility, independence, and staying healthy.

What is Durable Medical Equipment (DME)?

Walkers and wheelchairs are examples of durable medical equipment, as are canes, crutches, hospital beds, commode chairs, patient lists, and blood sugar monitors. For something to qualify as DME, it should be used in your home, for a medical reason, and have an expected lifetime of at least three years. It must be durable (can withstand repeated use), and it’s usually not for someone who isn't sick or injured.

Things You Need to Know:

A Doctor Must Prescribe DME for in-Home Use

Medicare Part B covers durable medical equipment when your doctor or treating practitioner (such as a nurse practitioner, physician assistant, or clinical nurse specialist) prescribes it for you to use in your home. You don’t have to be homebound, but you do need to use it at home. A hospital or nursing home that is providing you with Medicare-covered care is not considered your “home” in this situation, but a long-term care facility can qualify as such.

The Amount You Pay May Vary

Costs depend on things like other insurance you have, how much your doctor charges, whether your doctor keeps assignment, the type of facility it is, and where you get your test, item or service.

If your physician determines that a walker or wheelchair is medically necessary, Medicare will help cover some of the costs.  If you have Original Medicare, generally you pay 20% of the Medicare-approved amount after you pay your Medicare Part B deductible for the year. Depending on what you need, Medicare requires that you either rent or buy the equipment – but sometimes you have a choice between the two options.

Medicare Advantage Plans (like an HMO or PPO) cover the same items and services as Original Medicare. However, your costs will depend on your plan. Call your plan and ask for “Utilization Management” to find out if the equipment is covered and how much you’ll have to pay.

Check With Suppliers

You must get your covered equipment or supplies, and replacement or repair services, from a Medicare-approved durable medical equipment supplier for Medicare to pay. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims. Ask your suppliers if they participate in Medicare before you get DME. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.

Learn more about Durable Medical Equipment here.