Does Medicare Cover Fall Prevention?

Yes, Medicare covers several services related to fall prevention, primarily through Medicare Part B. If you are at risk of falling, Medicare helps pay for risk assessments, physical therapy, and certain medical equipment designed to keep you safe and independent in your own home. The key is that these services must be deemed medically necessary by your doctor.

When you first enroll in Medicare Part B, you are eligible for a "Welcome to Medicare" preventive visit. During this visit, your doctor will review your medical and social history, which includes assessing your risk for falls. If you have been on Medicare Part B for longer than 12 months, your Annual Wellness Visit will also include a review of your functional ability and level of safety, which directly addresses fall prevention.

If your doctor determines that you are at a high risk for falls, they may prescribe physical therapy. Medicare Part B covers outpatient physical therapy when it is medically necessary and prescribed by a doctor. A physical therapist can work with you on balance, strength, and mobility exercises specifically designed to reduce your risk of falling. You will typically pay 20% of the Medicare-approved amount for these services, and the Part B deductible applies.

We believe that protecting what you've earned includes protecting your physical independence. You shouldn't have to navigate the maze of Medicare rules alone when your safety is on the line. Straight answers, no surprises - that's how we operate. We are on your side of the table, ready to walk you through every option to ensure you have the coverage you need.

In addition to therapy, Medicare Part B may cover certain Durable Medical Equipment (DME) that can help prevent falls. This includes items like canes, walkers, and wheelchairs, provided your doctor prescribes them for use in your home. However, it is important to note that Medicare generally does not cover home modifications, such as installing grab bars in the bathroom or building wheelchair ramps, as these are not considered medical equipment.

If you have chosen the Traditional Medicare path (Part A and Part B), a Medicare Supplement (Medigap) plan can help cover the out-of-pocket costs associated with these services, such as the 20% coinsurance for physical therapy and DME. Remember, the supplement decision comes AFTER you choose Traditional Medicare - it's a component of the Traditional path, not an alternative to Advantage. If you choose a Medicare Advantage plan, your coverage for fall prevention services must be at least as good as Original Medicare, but your costs and network restrictions will vary by plan.