Will Medicare Cover Canes?
Medicare will cover most of the cost of canes if you have an honest need for them. You have an honest need if you need extra support when you walk. 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 the salesperson tells you.
- The doctor must document the need in your medical records 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 have supplemental insurance, or Medigap, you might not owe anything for your cane.
How Do I Qualify for a Cane Covered by Medicare?
If you have been admitted to 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's 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, it must meet Medicare's test of durability. Medicare will pay for medical equipment when:
- It will be used repeatedly: for example, a cane 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.
- 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 need for the cane must be to help you move independently in your home. Medicare does not cover canes if their primary use will be for recreational activities.
What Will It Cost For A Cane?
How much you pay will depend on your Medicare coverage. If you are enrolled in Medicare Part B:
After you have paid your yearly deductible, you will pay 20 percent of the approved Medicare amount. Be sure to buy your cane form a supplier who accepts assignment. A supplier who accepts assignment has agreed to not to charge more than the Medicare approved amount. If you have a Medigap policy or receive you care through a Medicare Advantage Health Plan, you may owe little to nothing depending on the plan you have and your benefits with the plan. Supplementary coverage is provided through a Medigap policy which pays part or all of the Medicare Part B copay after Medicare pays their part.
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. For more information call 1-800-MEDICARE (1-800-633-4227).
Who Supplies Canes?
You will save money if you order your item from a Medicare approved supplier. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your cane from any store that sells them. However, if the supplier from which you order your cane 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 will not charge more than the Medicare allowed amount.
- A Medicare approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the cane. In this situation Medicare will send the reimbursement directly to you, however, be prepared to wait; it may take a couple months to receive payment.
Remember: If you have a Medicare Advantage Plan (Part C) or supplemental insurance (Medigap), you might owe little to nothing for your cane.