Medicare can provide coverage for a walker that includes a seat, commonly known as a rollator, but only under specific regulatory conditions. A rollator is a four-wheeled mobility device that features hand brakes and an attached seat. Coverage hinges entirely on whether a medical professional deems the equipment necessary for a diagnosed health condition. To secure coverage, beneficiaries must follow a specific process involving their doctor and an approved equipment supplier.
How Medicare Classifies Walkers with Seats
Medicare classifies walkers with seats as Durable Medical Equipment (DME). DME is a regulatory category for items that can withstand repeated use, are used for a medical reason, and are not generally useful to someone without an illness or injury. Walkers, including standard models and four-wheeled rollators, all fall under this broad DME classification.
The portion of Original Medicare that covers DME is Medicare Part B, which is Medical Insurance. This coverage is specifically for medically necessary equipment prescribed for use in the beneficiary’s home.
Since a rollator is more sophisticated than a standard walker, it must be medically justified over a less complex device. Medicare will only cover the most basic version of the rollator that meets the patient’s medical needs. If a beneficiary chooses a model with enhanced features, such as specialized accessories, those non-medical upgrades may not be covered.
Essential Requirements for Coverage Approval
Securing Medicare coverage requires demonstrating strict medical necessity, meaning the equipment must be required for the diagnosis or treatment of an illness or injury. The walker must be needed to help the individual complete mobility-related activities of daily living, such as toileting or dressing, specifically within their home.
The first step is obtaining a written prescription, often called a Standard Written Order, from a treating physician. This document must include a detailed description of the exact item needed, such as a “four-wheeled walker with seat,” and the relevant diagnosis codes. The order confirms the physician believes the rollator is necessary to improve or maintain the patient’s mobility.
A crucial requirement is a documented, recent face-to-face examination with the prescribing doctor. This visit must confirm the patient’s mobility impairment and establish why a rollator is necessary over simpler mobility aids. The medical record from this visit must contain the evidence that justifies the need. The doctor’s notes and the written order must then be provided to the equipment supplier for claim processing.
Patient Costs and Choosing a Medical Supplier
Even with a physician’s order and approved medical necessity, the beneficiary will still have out-of-pocket costs for the rollator. Under Original Medicare Part B, the patient must first meet the annual deductible. Once that yearly amount is satisfied, Medicare pays 80% of the Medicare-approved amount for the equipment.
The patient is responsible for the remaining 20% of the cost as a coinsurance payment. Beneficiaries with supplemental insurance, such as a Medigap policy, may have some or all of this 20% coinsurance covered by that plan.
It is important to obtain the rollator from a supplier who is enrolled in Medicare and accepts “assignment.” Accepting assignment means the supplier agrees to accept the Medicare-approved amount as full payment for the item. If a supplier does not accept assignment, they can charge the beneficiary an unrestricted amount, leaving the patient responsible for the difference. Beneficiaries should confirm the supplier is an approved provider before acquiring the equipment to avoid paying the full price.