Does Medicare Cover Crutches?
Yes, Medicare covers crutches when a doctor deems them medically necessary. Crutches fall under Medicare Part B, known as medical insurance, which helps pay for outpatient services, preventative care, and supplies. This extends to durable medical equipment, or DME, such as crutches, walkers, and wheelchairs.
To qualify for Medicare-covered crutches, you must receive a prescription from a doctor. Then, you can rent or buy your crutches through a supplier that accepts assignment, meaning they only charge the Medicare-approved amount. You’ll only pay 20% of the cost if you’ve met your deductible.
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The Benefits of Crutches
Crutches help increase independence and mobility. Whether temporary or permanent, crutches aid people who struggle with balance or stability and need to take the weight off their legs. For example, someone might use crutches while they recover from surgery, heal a broken bone, adjust to a lost limb, or manage a disability. Types of crutches include:
- Axillary crutches: Also known as underarm crutches, this type features two poles and an axilla bar, or hand grip. These are the most common and least expensive, making them useful in temporary situations.
- Platform crutches: These include a padded forearm platform, which allows the forearm to lay flat while offering support. This helps people who can bear partial weight in their legs but need less pressure on their hands, such as those with rheumatoid conditions.
- Forearm crutches: These have asingle upright pole with a forearm cuff and hand grip. These are useful for individuals managing lifelong disabilities.
Understanding Medicare Coverage for Crutches
Medicare can help you pay for crutches if you meet specific eligibility requirements.
Eligibility
To qualify for Medicare-covered crutches, both your doctor and supplier must be enrolled in Medicare. Your provider must write a prescription, order, or certificate, which you can take to an approved supplier. Medicare will cover 80% of the cost if you meet the following requirements:
- You are enrolled in Medicare Part B or Medicare Advantage.
- You have met your Part B deductible.
- You intend to use the crutches in your residence. In some cases, a long-term care facility qualifies as your home.
Medicare Part A Coverage
Medicare Part A, known as hospital insurance, covers inpatient hospital care, skilled nursing facility care, home health care, and hospice care. If you’re admitted to the hospital, Part A helps cover nursing, meals, medication, and supplies.
During a covered stay at a skilled nursing facility, the facility must supply DME to use on-site, such as crutches, for up to 100 days. However, Part A will not pay for crutches that help you at home.
Medicare Part B Coverage
Medical supplies for home use, including crutches, fall under Medicare Part B. Sometimes referred to as “medical insurance,” Part B also covers outpatient services and preventative care. Together, Part A and Part B make up “Original Medicare.” Some people are automatically enrolled in both parts when they turn 65, but Part B is optional.
If you enroll in Part B, Medicare will pay for 80% of eligible DME after you meet your deductible. Your DME supplies must meet the following criteria to be covered under Medicare:
- Durable: The item can be used repeatedly and is expected to last at least 3 years.
- Medically necessary: The item serves a medical purpose, and a doctor prescribes it.
- For home use: You need the item to complete daily tasks within your residence.
Medigap Coverage
Medigap plans, also known as Medicare Supplement insurance, help cover out-of-pocket healthcare costs for Original Medicare beneficiaries. If you purchase crutches and Medicare pays for 80%, your Medigap plan may cover all or part of your remaining portion. Medigap coverage varies by location and type of plan.
How Does Medicare Advantage Cover Crutches?
Medicare Advantage plans, sold by private insurance companies, must meet minimum coverage requirements set by Original Medicare. These plans often bundle Part A, Part B, and Part D (prescription drug coverage). In many cases, Medicare Advantage plans extend coverage or offer more flexibility in providers and services.
If you purchase a Medicare Advantage plan, it must cover crutches, but the insurer may place different rules on that coverage. For example, you may have to shop within the plan’s network of suppliers or buy a specific brand of crutches. Since each plan employs its own requirements, check with your insurer before making any purchases.
How Much Do Crutches Cost With Medicare?
Compared with other medical supplies, crutches tend to be relatively inexpensive. However, the price varies by type and supplier.
Cost without insurance | |
|---|---|
Axillary crutches | $15-$50 |
Forearm crutches | $50-$100 |
Platform crutches | $150-$250 |
Extra tall or more ergonomic crutches may cost more than the above prices.
Medicare can significantly lower the out-of-pocket expense associated with crutches.
Part A Costs
Part A does not help pay for at-home crutches, but it covers supplies during a hospital or skilled nursing facility stay. If admitted to a hospital, beneficiaries must meet a deductible before Medicare helps pay. In 2023, the deductible is $1,600; in 2024, the deductible is $1,632.
Most beneficiaries do not pay a premium for Part A because they worked and paid Medicare taxes. Those who do not qualify for premium-free Part A pay $278 or $506 each month, depending on how long they or their spouse worked.
Part B Costs
If you need crutches to help at home, Part B covers 80% of the cost after you hit your deductible. In 2024, you must pay $240 before Medicare starts to pay. After that, you can purchase crutches for a 20% coinsurance. This lowers the price to $3-$10 for axillary crutches, $10-$32 for forearm crutches, or $30-$50 for platform crutches.
To maintain this coverage, you must pay a monthly Part B premium of $174.70 in 2024.
Medicare Advantage Costs
You still need to pay for Part B if you enroll in a Medicare Advantage plan, in addition to the private insurer’s premium. In 2024, Medicare Advantage premiums cost an average of $18.50, but this price varies significantly depending on the company and type of plan.
While Medicare Advantage plans must cover crutches, their coverage and costs may differ from Original Medicare. Each private insurance plan has its own deductible, coinsurance, and out-of-pocket maximum. Your plan may offer higher coverage for crutches if you purchase within its network of suppliers.
How to Get Medicare-Covered Crutches
You must follow Medicare’s procedure to get your crutches covered.
- Talk to your doctor. Make sure your provider is enrolled in Medicare. You may have to meet face-to-face to get an order or prescription for crutches.
- Determine what type of crutches you need. Your doctor can help you find a comfortable fit. At this time, decide whether you need to rent or buy.
- Use the Medicare website to search for suppliers in your area. Look for ones that accept assignment. Medicare will only pay 80% of its approved cost, even if your supplier charges more.
- Rent or purchase your crutches. You may need to present your doctor’s order and complete a form. If you’ve met your deductible and chosen a supplier that accepts assignment, you will only pay the 20% coinsurance. The supplier will submit your claim directly to Medicare.
Medicare-Covered Alternatives to Crutches
Not every situation requires crutches. If you need less support, you might opt for a cane or walking stick, but if you need more stability, you may benefit from a scooter. Medicare covers several DME walking aides, including:
- Canes
- Walkers
- Wheelchairs
- Scooters
Notably, Medicare does not cover knee scooters. These feature a cushioned leg rest, wheels, and a steering handle, and they may feel safer or more comfortable to some users. Depending on the plan, you may receive coverage through Medicare Advantage.
For supplies that do meet DME requirements, Medicare pays for 80% of the cost. However, Medicare places strict rules on more expensive equipment. For example, a power wheelchair that you mainly use outside would not be considered DME. To get a Medicare-covered power wheelchair, your doctor must confirm that you cannot perform daily tasks at home, even by using a walker. Then, Medicare will verify that the power wheelchair actually fits in your residence.
All in All
Crutches take some getting used to, but they can significantly increase your independence. Consult your doctor to determine which type of crutches work for your situation, and consider other walking aides as an alternative. If possible, try out different options and sizes to find the best fit for your mobility and height.
If your crutches qualify as DME, take the time to research approved suppliers. Otherwise, you may incur extra out-of-pocket costs.