Does Medicare Pay for a Walking Cane?

Medicare plays a significant role in helping millions of Americans access necessary healthcare services and equipment. This federal health insurance program provides a framework for coverage, assisting beneficiaries with various medical needs.

Medicare Part B and Durable Medical Equipment

Walking canes are considered durable medical equipment (DME) by Medicare. Durable medical equipment includes items that are long-lasting, used for a medical purpose, are generally not useful to someone without an illness or injury, are appropriate for use in the home, and are expected to last for at least three years.

Medicare Part B, which is the medical insurance component of Original Medicare, covers DME when it is prescribed by a doctor or other healthcare provider for use in a beneficiary’s home. This coverage extends to various types of canes, including standard, quad, and folding canes, provided they meet the medical necessity criteria. Other common DME items covered under Part B include walkers, wheelchairs, hospital beds, and oxygen equipment.

Meeting Medicare’s Coverage Criteria

For Medicare to cover a cane, specific requirements must be met, centering on the concept of medical necessity. A doctor or other healthcare provider must officially prescribe the cane, stating it is needed for a medical condition or injury.

This prescription serves as documentation that the equipment is necessary to help with mobility challenges that significantly impair a person’s ability to perform daily activities within their home. These activities include essential tasks such as toileting, feeding, dressing, grooming, and bathing.

The medical record must clearly support the need for the cane, indicating that it will resolve a functional mobility deficit or prevent a heightened risk during these activities.

Steps to Obtain a Cane

Once a cane is deemed medically necessary and prescribed by a healthcare provider, the next step involves obtaining the equipment from a Medicare-approved supplier. It is important to ensure the supplier is enrolled in Medicare and accepts “assignment”.

When a supplier accepts assignment, they agree to accept the Medicare-approved amount as full payment for the item, which helps control a beneficiary’s out-of-pocket costs. If a supplier does not accept assignment, they may charge more than the Medicare-approved amount, and the beneficiary could be responsible for the difference.

Under Original Medicare Part B, after the annual deductible is met, Medicare typically pays 80% of the Medicare-approved amount for the cane, and the beneficiary is responsible for the remaining 20% coinsurance.

Medicare Advantage Plans (Part C) are required to cover the same DME items as Original Medicare, but they may have different rules, networks of suppliers, or require prior authorization for coverage. Beneficiaries with Medicare Advantage plans should contact their plan directly to understand their specific cost-sharing and supplier requirements.