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What does Medicare Part B pay for that may reduce my fall risk?
Home | Resources | What does Medicare Part B pay for that may reduce my fall risk?
Having the proper equipment to use in your home is essential to reduce your fall risk.

Though we do not provide the equipment, we can certainly help you to obtain them. If you are on our caseload, we can send a referral to the appropriate medical supply company.

(content adapted from: Medicare.gov's Durable Medical Equipment Coverage Info)

Therapeutic Shoes & Inserts

Medicare Part B (Medical Insurance) covers the furnishing and fitting of either of these each calendar year, if you have diabetes and severe diabetic foot disease:
  • One pair of custom-molded shoes and inserts
  • One pair of extra-depth shoes
Medicare also covers:
  • 2 additional pairs of inserts each calendar year for custom-molded shoes
  • 3 pairs of inserts each calendar year for extra-depth shoes

Medicare will cover shoe modifications instead of inserts.

The shoes and inserts must be prescribed by a podiatrist (foot doctor), or other qualified doctor and provided by one of these:

  • A podiatrist
  • An orthotist
  • A prosthetist
  • A pedorthist
  • Another qualified individual

Your costs in Original Medicare

If your supplier accepts assignment, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Medicare will only cover your therapeutic shoes if your doctors and suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren't enrolled, Medicare won't pay the claims submitted by them.

The following criteria must be met for Medicare to pay for DME (Durable Medical Equipment)

  • Durable (can withstand repeated use)
  • Used for a medical reason
  • Not usually useful to someone who isn't sick or injured
  • Used in your home
  • Generally has an expected lifetime of at least 3 years

Commode Chairs

Medicare Part B (Medical Insurance) covers commode chairs as durable medical equipment (DME) when your doctor orders them for use in your home if you can’t use a regular toilet.

Your costs in Original Medicare

If your supplier accepts assignment you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:
  • You may need to rent the equipment.
  • You may need to buy the equipment.
  • You may be able to choose whether to rent or buy the equipment.

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.

Hospital Beds

Medicare Part B (Medical Insurance) covers hospital beds as durable medical equipment (DME) that your doctor prescribes for use in your home.

Your costs in Original Medicare

If your supplier accepts assignment you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:
  • You may need to rent the equipment.
  • You may need to buy the equipment.
  • You may be able to choose whether to rent or buy the equipment.

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.

Canes, Walker, Rollators

Medicare Part B (Medical Insurance) covers canes as durable medical equipment (DME). Medicare doesn't cover white canes for the blind.

Your costs in Original Medicare

If your supplier accepts assignment you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:
  • You may need to rent the equipment.
  • You may need to buy the equipment.
  • You may be able to choose whether to rent or buy the equipment.
Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.

Wheelchairs & Scooters

Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home.

You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair. Part B covers power wheelchairs only when they're medically necessary.

Your costs in Original Medicare

If your supplier accepts assignment you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:
  • You may need to rent the equipment.
  • You may need to buy the equipment.
  • You may be able to choose whether to rent or buy the equipment.
Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.

*Starting September 1, 2018, you may have to get prior approval (known as “prior authorization”) for certain types of power wheelchairs. Under this program, 40 types of power wheelchairs require “prior authorization” before Medicare will cover the wheelchair cost.

Your DME supplier will need to:

  • Request “prior authorization”
  • Send the request and required documents to Medicare
You don’t need to do anything. If your physician prescribes one of these wheelchairs to you, your DME supplier will, in most cases, submit a prior authorization request and all documentation to Medicare on your behalf. Medicare will review the information to make sure that you’re eligible and meet all requirements for power wheelchair coverage. Your Medicare coverage and benefits will stay the same, and you shouldn’t experience delays getting the items you need.

Your prior authorization request may be denied if:

  • Medicare finds you don’t medically require a power wheelchair
  • Medicare doesn’t get all the information needed to make a decision

If additional information is needed, your DME supplier may resubmit your prior authorization request.

Patient Lifts

Medicare Part B (Medical Insurance) covers patient lifts as durable medical equipment (DME) that your doctor prescribes for use in your home.

Your costs in Original Medicare

If your supplier accepts assignment you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:
  • You may need to rent the equipment.
  • You may need to buy the equipment.
  • You may be able to choose whether to rent or buy the equipment.
Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.