When I first started researching walkers for dad, we were curious if either Medicare or Medicaid would cover some (maybe even all) of the cost. The idea of getting a nice rollator for free did sound pretty good, let me tell you! In this post I’m going to share with you exactly what I discovered.
YES, Both Medicare and Medicaid do cover walkers and rollators, with a few caveats. They will cover Durable Medical Equipment (DME) that is deemed medically necessary, has been prescribed by a doctor, and is cost effective.
However, the devil is in the details…
For example, Medicare may only cover 80% of the walker, while you are responsible for the rest. And you probably won’t get to choose the walker you want.
With Medicaid, there isn’t one set of rules determining if they will pay for your walker or not. The rules vary state to state, and they depend on which Medicaid sub-program you are in.
In fact there are hundreds of different rules based on the combination of your location and the program you’re enrolled in. This is because Medicaid program benefits and eligibility rules are determined at the sub-program level by each state. So it’s not as simple as a yes/no answer.
Will Medicare / Medicaid pay for my walker?
Generally speaking, here is when your walker or rollator will be covered:
- It must be medically necessary. Walkers are considered to be medically necessary if they are “needed to diagnose or treat an illness, injury, condition, disease, or its symptoms”. You will need a a qualified health care provider to make this decision.
- It must be prescribed. You will need a prescription from a doctor, advanced registered nurse practitioner, or a podiatrist for your walker to be covered by Medicare or Medicaid.
- It must be prescribed and supplied only by those who are enrolled in Medicare. Both the doctor and the supplier of the walker need to be enrolled in Medicare and accept assignment. This simply means they have agreed to be paid by Medicare/Medicaid.
- It must be cost effective. This usually means they will only cover basic walkers. For example, Medicaid may determine it is medically necessary for you to have a walker or rollator. But they might come to the conclusion you only need an entry-level walker to get around the house, rather than a higher quality rollator that would allow you to traverse over grass or bumpy sidewalks.
Your diagnosis, situation, and the type of equipment you’re after will determine whether you must rent the walker, can buy it, or have the choice to either rent or buy.
With some of the deals you can find on Amazon, in many cases it’s actually cheaper to buy rather than rent. So if you’re only approved to rent I’d take a look at what Amazon has to offer because you can most likely save yourself some money. And if you own the walker you can always sell it when you don’t need it anymore and make some money back.
How often will medicare pay for a walker?
Medicare will pay for a walker once every 5 years. The lifetime of a DME product is determined by Medicare to be 5 years, so if your walker is worn out (or you just want a new one), Medicare will only replace it if you’ve had it for the full 5 year period. To qualify for replacement, the product must be so worn out that it cannot be fixed. Otherwise, Medicare will cover repairs up to the cost of a replacement. (You can only use Medicare-approved suppliers to make repairs.) You’ll also need to get another prescription from your health provider.
What if my walker is lost or stolen?
In the case of your walker or rollator being lost, stolen, or damaged beyond repair in an accident, Medicare will replace it with a similar item. You’ll just need to produce proof of the theft such as a police report.
How many walkers will medicare pay for?
Medicare will only pay for one walker or rollator. If you need both a walker and a wheelchair, they will only pay for one or the other, not both. You’ll most likely have to foot the bill for the other one. Or if you’d like one small walker for home, and another rollator for out and about, Medicare / Medicaid will only pay for one of them.
Does Medicare pay for walkers with seats?
Yes a walker with a seat falls under the same classification as other walkers (Durable Medical Equipment) and will be covered by Medicare, under the same four conditions listed above.
What about upright walkers & medicare?
Upright walkers fall under the same rules and regulations as all other walkers and rollators. So to determine if your upright walker will be covered by Medicare you need to answer the 4 eligibility questions in the affirmative: Is it medically necessary? Was it prescribed by a doctor, nurse, or podiatrist? Was it prescribed and supplied by those enrolled in Medicare? And is it cost effective?
Where can I find a Medicare approved walker supplier?
The Medicare website has a list of participating suppliers which you can find here.
What’s the difference between Medicare and Medicaid?
Medicaid is a State and Federal partnership. It provides coverage for low income, elderly, disabled, and families with children. Durable Medical Equipment (DME) — which includes walkers and rollators — is included in this cover.
Medicare is a Federal program. Part B, which is voluntary and has a monthly premium involved, covers Durable Medical Equipment (DME) that is medically necessary. Medicare may cover 80% of the allowed amount, and you are responsible for the remaining 20%.
Still not sure if you’re covered?
The rules can be fickle and are constantly changing, so if you have any questions or concerns you can call 1-800-MEDICARE or contact your local Medicaid office to learn more about costs and coverage.