A walker is a mobility aid designed to provide stability and support for individuals who experience difficulty walking. Medicare classifies these devices as Durable Medical Equipment (DME). DME includes items that are medically necessary, can withstand repeated use, and are expected to last for at least three years. Since a walker is categorized as DME, it is covered under Medicare Part B, which addresses outpatient care and medical supplies. Securing coverage for a walker requires navigating a specific administrative process that begins with establishing the medical need for the device.
Meeting Medicare’s Eligibility Requirements
The threshold for Medicare coverage rests entirely on the concept of medical necessity, which must be clearly demonstrated for the walker to be approved. This means the device must be required for you to diagnose, manage, or treat an illness, injury, or condition that affects your mobility. Specifically, you must have a mobility limitation that significantly impairs your ability to participate in one or more mobility-related activities of daily living (MRADLs) within your home. The limitation must be severe enough to prevent you from accomplishing these activities entirely, or place you at a heightened risk of injury while attempting them.
A walker is generally covered if the medical evidence shows that a cane or crutches are insufficient to meet your mobility needs. The documentation must confirm that the functional mobility deficit can be sufficiently resolved by using a walker and that you are able to safely operate the device. Medicare’s coverage for DME is focused on use in the home. If the medical record indicates the walker is only necessary for use outside the home, the request will typically be denied because the DME benefit requires the equipment to be for home use.
The Role of Your Doctor and Prescription
The formal process for obtaining a covered walker begins with your treating physician, who must be enrolled in Medicare. You must have a face-to-face examination with this doctor before they can issue a written order for the equipment. This examination is crucial because the physician must document the specific medical reason why the walker is necessary, directly linking your diagnosis and mobility impairment to the need for the device.
This documentation, often referred to as a Standard Written Order (SWO), must specify the type of walker required and include a detailed narrative describing your functional limitations. Vague descriptions like “difficulty walking” are usually insufficient to meet the coverage criteria for medical necessity. The physician’s detailed notes must be available to the supplier upon request and clearly describe your functional abilities and limitations. This prescription and supporting documentation must be in place before the equipment is delivered.
Choosing an Approved Supplier
Once you have the necessary physician’s order, you must select a supplier who meets Medicare’s strict standards. The walker must be obtained from a supplier enrolled in the Medicare program. Using a supplier who is not enrolled in Medicare will result in the entire cost of the walker being your responsibility.
It is recommended that you choose a supplier who accepts “Medicare assignment,” as this directly impacts your out-of-pocket costs. When a supplier accepts assignment, they agree to accept the Medicare-approved amount as the total payment. This agreement protects you from being charged more than the Medicare deductible and coinsurance amount. If a supplier does not accept assignment, they can legally charge you up to 15% more than the Medicare-approved amount, which is known as balance billing.
Understanding Your Financial Responsibility
Coverage for the walker falls under Medicare Part B, meaning you are responsible for certain out-of-pocket costs even after the item is approved. You must first meet the annual Medicare Part B deductible before Medicare begins to pay its share.
After your deductible has been met, Medicare will pay 80% of the Medicare-approved amount for the walker. This leaves you with a coinsurance responsibility of 20% of the Medicare-approved amount. If the walker you select has enhanced features or accessories that Medicare does not consider medically necessary, you will be responsible for the entire cost difference of those upgrades. Choosing a supplier who does not accept assignment can further increase your financial burden.