Ivan Vargas, a 70-year-old Richmond man, was helping his son-in-law with a home renovation project in 2020 when he fell through the home’s ceiling, suffering a T10 spinal cord injury that left him paralyzed.
Four years later, Vargas is walking again with the help of a robotic exoskeleton.
Previously, the cost of purchasing the device — nearly $100,000 — would have prevented him from buying it. But as part of a rule change that went into effect in January, the Centers for Medicare & Medicaid Services reclassified “certain exoskeleton-type devices” as braces, allowing them to be covered by Medicare when medically necessary.
That change marked the first time CMS addressed coverage of braces with power features, according to an agency spokesperson.
Vargas began learning how to use his exoskeleton in August with the aid of physical therapists at Sheltering Arms Institute's outpatient facility in Hanover County and assistance from his wife Connie, who is needed to help her husband operate the device. It can take up to 50 hours of demanding training sessions for a patient to learn how to rely on the device to help them stand up, sit down and walk.
In 2012, the Defense Department’s research and development agency initiated a research grant to develop the first powered exoskeleton to assist soldiers carrying heavy loads.
Ekso Bionics manufactures healthcare exoskeletons and robotics for health care uses, including the Indego, which Vargas now uses to walk. Rachael Anderson, the company’s director of home health sales, says the device eventually transitioned from a military-focused tool into the civilian health care sector.
“We wanted to cover the whole rehab journey of someone who might have a spinal cord injury,” Anderson said. “It would provide all of the power to their legs, so that if they had none it would basically walk for them.”
The Vargases completed their training and took Ivan’s exoskeleton home in late September. He is the first person on the East Coast to get his device covered by Medicare, according to Sheltering Arms Institute. Medicare covers about 80% of the price tag, which is just over $91,000. The patient is responsible for the remaining cost, either out of pocket or through secondary insurance coverage.
Prior to the CMS rule change, the majority of people using at-home exoskeletons were veterans who either had enough money to pay out of pocket or were able to get their devices covered by the Department of Veterans Affairs.
“This was very exciting that CMS approved this,” Richard Bagby said about the decision to expand Medicare coverage to include exoskeletons.
Bagby, the United Spinal Association of Virginia’s executive director, has been using a wheelchair since fracturing his spine in 2008. His nonprofit works to help people live as independently as possible after a spinal cord injury.
He said there are personal benefits associated with exoskeletons, “one of which is just being a wearable device that someone can strap on and mobilize throughout the community.”
“You are improving people’s health, happiness, livelihood, so they can get back to work quicker.”
Bagby said the upfront expense for the device with federal funding may help decrease the burden on taxpayers down the road.
Christina Smith, Sheltering Arms Institute’s therapy services manager, also sees long-term health benefits of the device.
“Patients with spinal cord injuries have a higher risk of cardiovascular disease just because it’s harder to get a cardio workout,” Smith said, giving the example that when a person is upright, “they can exercise the same as someone else who could go for a walk.” That in turn helps them to “ward off other diseases and diagnosis.”
Not everyone with a spinal cord injury can use the devices. There are height and weight restrictions, and Smith says it’s important the patient is highly motivated to use the exoskeleton and that they have a caregiver who can help put the device on and transport it.
Smith said exoskeletons aren’t yet meant to replace wheelchairs, but they can help improve a patient’s quality of life. Bagby said he hopes that the technology will continue to evolve to the point where exoskeletons can be a wheelchair replacement.
In an interview, Vargas told Sheltering Arms Institute that it was life-changing for him: “I can go to church, I can go see my grandkids play sports, I can volunteer my time someplace. It will be a freedom for me to be able to walk.”
Medicare’s decision to cover the device may be a first step in expanding access for everyone. Anderson said commercial insurers could decide to pay for the device now that Medicare is providing coverage.
Bagby said he envisions more innovation and improvement with the new technology as more consumers begin to use them.
“If you think of the iPhone when that first came out, [to] now,” Bagby said, “It’s just improvement on improvement. Right now, exoskeletons are improving people’s lives 100% and we’re just incredibly excited about what potential that has.”