Since I work at a durable medical equipment supply company, I get questions like this all the time. Especially on entry level mobility aids like canes and walkers. Many seniors and their families are not aware of Medicare coverage criteria. And… Medicare doesn’t make it easy to figure out sometimes. So, does Medicare pay for walking canes? Yes, they do. Read on to find out how it works and the full process for getting a walking cane covered by Medicare.
Medicare Coverage Requirements for Walking Canes
Medicare establishes rigorous and strict coverage requirements for any product they cover. Walking aids like canes are no exception. It is also expected that doctors, nurses, and physician assistants know and understand all of these policies. The following conditions are necessary for Medicare to cover and pay for a walking cane. Hang on, this may get a little wordy. This language comes straight from Medicare Local Coverage Determination documents.
- The beneficiary has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) in the home.
The MRADLs to be considered in this and all other statements in this policy are toileting, feeding, dressing, grooming, and bathing performed in customary locations in the home.
A mobility limitation is one that:
- Prevents the beneficiary from accomplishing the MRADL entirely, or,
- Places the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform an MRADL; or,
- Prevents the beneficiary from completing the MRADL within a reasonable timeframe;
- The beneficiary is able to safely use the cane or crutch; and,
- The functional mobility deficit can be sufficiently resolved by use of a cane or crutch.
OK, now, take a deep breath….
So, what does all that mean?
Honestly, it is a lot of legalistic language that says the person getting the cane needs it to take care of themselves and that they can use it safely.
All of that MRADL stuff above (in Criteria#1) is just the activities most of us do every day at home to take care of ourselves. Like, feeding ourselves, getting dressed, and going to the bathroom and so forth. So, Medicare wants to know that person getting the cane is unable to do one of those things because of their problem walking. An example is they live alone and cannot walk enough to get something to eat. Or, they are unable to make it to the bathroom on time because they walk slowly.
The second criteria are about safety. Medicare just wants to know that the prescriber has taken into account the safety of the senior who needs a cane. If they cannot safely use the cane, other equipment should be considered. Perhaps a walker with wheels, a rollator with seat, or even a wheelchair may be more appropriate.
The final criteria have always seemed a little weird to me. Medicare wants to know that the cane will actually fix the problem. If the user gets a cane, Medicare wants confirmation that the user can use the cane to the kitchen or bathroom now.
Plain Language: Medicare Coverage Criteria for Walking Canes
OK, so in real language, here is my summary of this criteria.
- The senior needs a walking cane because, without one, they cannot:
- Get to the bedroom for dressing and changing clothes
- Get to the bathroom for toileting
- Get to the bathroom for bathing or personal hygiene
- Get to the kitchen or dining room for feeding
- The senior can safely use a cane without risk of falling.
- Having a cane will actually fix the problem identified in point #1.
Hopefully, that is a little more readable and understandable.
How to get Medicare to Pay for Walking Canes
The first step in getting a cane covered by Medicare is to call your doctor. You will need an order/prescription for a cane. While there is no specific face to face requirement for a cane, your doctor may have you come in for an exam.
Once you have an order or prescription in hand, take it to a local durable medical equipment (DME) company and pick out a cane. Make sure the store you visit participates in Medicare. You will have to give the DME your insurance information and probably fill out a few more forms. The DME store may have a few options to choose from but your choice will probably be limited. And here is why.
There is a published fee schedule that limits what Medicare will pay for walking canes. Currently, the payment for a cane (E0100) is between $20 and $25. The payment for a quad cane (E0105) is $45.00 to $50.00. Because of what canes cost the dealer and the payment Medicare pays them for canes, medical equipment stores break even on most cane purchases. And this is for basic canes. This is why a DME cannot provide the higher end, more stylish canes to Medicare beneficiaries. And, the cane must carry this code to be covered which is why specialty canes and walking sticks are not covered by Medicare.
Also, note that Medicare only pays for 80% of their payment amount for the walking cane. The senior will have a 20% out of pocket copay ranging from $4 to $10 depending on the cane they choose. Some seniors have secondary insurance plans or Medicare replacement policies that may pay this difference.
Alternatives to Having Medicare Pay for Walking Canes
It is becoming more and more common for seniors and elders to NOT use their Medicare benefits for basic medical equipment. Some don’t want to hassle with paperwork. Women usually want a more stylish walking cane or one with more features like lights or alarms. There are some alternatives:
- Use a Medicare Upgrade. Medicare does allow for upgrades with the senior paying the difference between the covered product and an upgraded product. There are some specific limitations to this policy that get pretty complicated. For example, if the cane you want to upgrade to is “coded” by Medicare, you cannot upgrade.
- Use a Health Savings Account to pay. If the user has an HSA or FSA account, use those accounts to pay for medical equipment.
- Buy the walking cane outright. More stylish walking canes with more options are available at retail stores and online for less than $30.00.
So, Does Medicare Pay for Walking Canes?
Yes, Medicare does pay for walking canes. And, the process is pretty simple compared to someother mobility products seniors need. The senior will need a prescription and probably a visit to their doctor. The DME company will need that prescription, the Medicare number, and a few forms completed. The senior often gets the walking cane the same day, although choice is probably limited. But, you probably won’t be able to get specialty canes for men or canes with extra features like lights covered.
Do you have any experience with Medicare paying for walking canes? What did you think about the process? Please share in the comments below. Also, feel free to ask any questions you have and I’ll get right back to you.