Insurance & Cost Guide

What Medicare Covers

Medicare Part B covers crutches as Durable Medical Equipment (DME) when medically necessary.

Requirements:

• ✓ Prescribed by Medicare-enrolled doctor
• ✓ Medically necessary for home use
• ✓ Obtained from Medicare-approved DME supplier
• ✓ Doctor must document medical necessity

Your Costs (2025):

• Annual Deductible: $240
• Coinsurance: 20% of Medicare-approved amount
• Example: $100 crutches = $20 out-of-pocket (after deductible met)

Rental vs. Purchase:

Medicare typically covers rental for 13 months. After 13 months of continuous rental payments, you own the equipment.

How to Get Coverage

1. Get a prescription from your doctor with diagnosis code
2. Find Medicare-approved supplier - search at medicare.gov/medical-equipment-suppliers
3. Verify coverage - Call supplier to confirm they accept Medicare assignment
4. Submit documentation - Supplier will bill Medicare directly
5. Pay your share - 20% coinsurance after deductible

Typical Coverage

Most private insurance plans cover crutches as DME, but specifics vary by plan.

Common Coverage Patterns:

• In-Network DME: $10-$40 copay after deductible
• Out-of-Network: 30-50% coinsurance (higher cost)
• Deductible: May need to meet annual deductible first ($500-$5,000)
• Pre-authorization: Some plans require approval before purchase

Steps to Verify Coverage:

1. Call number on back of insurance card
2. Ask: "Are crutches covered under DME?"
3. Ask: "Do I need pre-authorization?"
4. Ask: "What's my copay/coinsurance?"
5. Ask: "Which DME suppliers are in-network?"
6. Get reference number for the call

Major Insurance Plans - Quick Reference

Note: Coverage varies by specific plan. Always verify with your insurance.

Tax-Free Savings

Crutches and accessories are qualified medical expenses for:

• Health Savings Accounts (HSA)
• Flexible Spending Accounts (FSA)
• Health Reimbursement Arrangements (HRA)

What's Covered:

• ✓ Crutches (all types)
• ✓ Replacement tips
• ✓ Padding and grips
• ✓ Crutch bags/accessories (if medically necessary)

How to Use:

1. Pay with HSA/FSA debit card at checkout
2. OR pay out-of-pocket and submit receipt for reimbursement
3. Keep receipt showing date, amount, and "crutches" or "DME"
4. May need doctor's note for some FSAs

National Programs

1. The Salvation Army

• Provides medical equipment loans/donations
• Contact: Find local office at salvationarmyusa.org
• Phone: Call 1-800-SAL-ARMY

2. Lions Clubs International

• Medical equipment loan program
• Find club: lionsclubs.org
• Often free or very low cost

3. Modest Needs Foundation

• Emergency grants for medical expenses
• Website: modestneeds.org
• Grants up to $1,000

4. Patient Advocate Foundation

• Financial aid for medical expenses
• Phone: 1-800-532-5274
• Website: patientadvocate.org

Free/Low-Cost Options

Freecycle Network

• Community exchange - often free medical equipment
• freecycle.org

Craigslist Free Section

• Check "free" section regularly
• Medical equipment often available

Hospital Social Services

• Many hospitals have loan closets
• Free equipment loans for discharged patients
• Ask your hospital social worker

Churches & Community Centers

• Many have medical equipment to lend
• Contact local churches, senior centers, community organizations

State Medicaid Programs

If you qualify for Medicaid, crutches are typically covered with:

• $0-$3 copay in most states
• Doctor's prescription required
• Must use Medicaid-enrolled DME supplier

Check eligibility: medicaid.gov or call 1-877-267-2323

How to Find In-Network Suppliers

1. Call your insurance - Ask for list of approved DME suppliers
2. Medicare.gov search tool - medicare.gov/medical-equipment-suppliers
3. Insurance company website - Provider directory under "DME" or "Medical Equipment"
4. Our Directory - Browse local suppliers with ratings

Questions to Ask Suppliers:

• Do you accept my insurance?
• Do you need pre-authorization?
• What will my out-of-pocket cost be?
• Do you offer rental options?
• What's your return/exchange policy?