Rollator walkers are one of the best medical devices for seniors. They’re perfect for those with balance or muscle issues, COPD, or those who need to recover from a surgery or accident. They keep seniors active, independent and are equivalent exercise to walking without the danger of a fall. This has many seniors asking, “does Medicaid cover walkers?”
The answer to this question, as with many other Medicaid-related questions, is complicated. The general answer is, yes, Medicaid will cover a rollator - as long as certain conditions are met.
These conditions are related to:
Let’s find out what these guidelines are, and learn how to get a rollator walker covered by Medicaid!
What is DME? Is a Rollator Walker Considered DME?
This is the first question that must be answered. In order to be covered by Medicare and Medicaid, something must be considered Durable Medical Equipment (DME).
According to the federal government, DME is “equipment and supplies ordered by a health care provider for everyday or extended use”. This could include wheelchairs, oxygen tanks, crutches, walkers, and more.
Since rollator walkers fall under that definition, they clear the first hurdle on their way to being covered by Medicaid and Medicare!
How Often Can You Get a Rollator on Medicaid?
Medicare and Medicaid regulations vary for how often seniors can get a rollator.
After the initial conditions for getting a rollator have been met, Medicare will allow you to get a walker every five years. However, if your walker is damaged, lost, or stolen, you can receive a replacement sooner.
Medicaid is a slightly different story, because it is more restrictive than Medicare, and because each state has different rules. For instance, Ohio has a very strict monthly income cap in order to qualify, whereas Virginia’s income cap is much higher. So, finding out whether your rollator is covered in your area isn’t as simple as we’d like!
However, unlike Medicare, Medicaid usually covers the full cost of the rollator walker, if it is approved. Medicare will only cover 80% of the cost and requires you to pay the rest.
Many seniors qualify for both programs. Which one should you choose to cover your walker? If you can get your rollator covered by Medicaid, and they approve a high-quality option, you may want to get it through Medicaid rather than Medicare.
If you’d like to check your state and program’s specific rules, you can head to the federal government’s directory or call 877-267-2323 to get information specific to your location!
Medicaid Guidelines for Rollator Walkers
Below, you’ll find guidelines that will govern whether or not a rollator walker is covered by Medicaid or Medicare, regardless of your state:
1. Must Be Medically Necessary
To get your rollator covered, you must truly need it. This is called having a “medical purpose”, and the primary medical purpose is to assist in moving independently around your home.
This could due a variety of reasons and conditions, but common reasons that necessitate a walker are:
How do you know if a walker is medically necessary? The only real way to know and prove this is with the next guideline:
2. Must Obtain Prescription/Written Authorization
In order for a rollator walker to be covered, it must be prescribed or cleared by a doctor after a face-to-face visit. Without that prescription, you will still be able to obtain a rollator walker, but you will have to pay out of pocket. The reason for this is to prevent fraud and to prevent potential budget issues that could arise.
If a doctor’s prescription were not required to get a rollator covered, it would become very easy to fraudulently receive free DME. That would allow people to steal someone’s information, receive the DME, and sell it for a profit. With a doctor’s prescription, however, this cannot happen. It may seem like yet another hurdle to clear, but it is a helpful one for all seniors.
Your doctor will examine your injury or other medical need and assess whether you could benefit from a rollator. This will almost always be a very easy assessment; the doctor only needs to know that you risk falling without one. Once the doctor decides, they write you the prescription, and you’re out the door!
Many times, the first two guidelines, “medical purpose” and “prescription mandatory” happen as a natural result of needing medical assistance. So, you should be able to obtain your rollator walker (or at least the prescription for it) during the normal process of receiving care. Ideally, you will always know upon leaving the doctor’s office or discharge from the hospital whether or not your rollator will be covered!
3. Medicare Must Be Accepted by Doctor and Provider
After you get your prescription, you must purchase or acquire your rollator walker from a provider that is in your Medicaid or medicare network. In other words, if the provider doesn’t accept Medicare or your Medicaid, you will have to pay out of pocket or find another provider.
Conclusion: Does Medicaid Cover Walkers?
Medicaid is a program that varies from state to state. While Medicaid will cover a rollator walker because it is considered a piece of Durable Medical Equipment (DME), there are rules and guidelines to follow.
If you have a medical purpose, a doctor’s prescription, and the provider of your rollator accepts Medicaid, you will have no problems getting it covered! Those may seem like tough hoops to jump through, and they can create headaches. However, it is nice to know that when you need a rollator, Medicaid and Medicare will help to get you one!