Does Medicare pay for wheelchairs and scooters?

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You can think that if you are 65 or older if you need a wheelchair or electric scooter to get around, Medicare may cover it. But, as with many areas of Medicare, things are not that simple.

Whether Medicare will cover the cost of a mobility device such as a manual wheelchair, power wheelchair or electric scooter depends on whether you meet all of its requirements.

“It’s not the easiest thing in the world,” says author Diane Omdahl Medicare for You and cofounder of a Medicare advisory firm, 65 Inclusion.

Manual wheelchairs, wheelchairs and scooters

To clear up any confusion about words: a wheelchair is one you drive or your carer does; An electric wheelchair (also called a power wheelchair or power chair) is for people who do not have the motor or heart capacity to use a manual wheelchair and an electric or power wheelchair helps users who cannot drive a manual bike and cannot use crutches. or walkers.

Even if you qualify for Medicare reimbursement for a mobility device, you’ll be on the hook for 20% of the eligible cost — your money — after you pay your Part B copay, which is $240 in 2024.

Medicare Reimbursement Rules

The first rule of Medicare coverage for wheelchairs or scooters is that you must have medical coverage in your home.

“That doesn’t mean you just use them in your home, but you need them in your home,” says Casey Schwarz, senior adviser for education and public policy at the agency. Medicare Rights Center.

Medicare will not cover a wheelchair or scooter if you need the device for mobility or when you travel. Traditional Medicare also will not pay for a wheelchair.

The second rule of thumb for reimbursement is what Medicare calls “minimum mobility.”

This means having all of these:

  • Illnesses that make it difficult to move around at home
  • Inability to perform daily activities such as bathing, dressing or using the bathroom with the help of crutches, crutches or walking.
  • Ability to operate a wheelchair or scooter or someone who is present to assist you

Study the tests and you will need a face-to-face examination from a doctor (who must participate in Medicare). The doctor will provide Medicare with a Certificate of Necessity stating that you need medical care and that they are treating you for the condition.

You may need an authorization from Medicare to reimburse the wheelchair, This is true whether you are in Medicare or the Medicare Advantage plan of insurance. The Medicare website has a list more than 40 electric vehicles that require prior approval.

“The provider and the health care provider will give consent,” says Schwarz. “If it is rejected or you need to provide more information, you can send another request.

Buy versus rent

You can buy or rent wheelchairs and scooters. Manual wheelchairs tend to cost between $1,000 and $2,000; wheelchairs can run more than $10,000. Electric scooters go for about $600 to $4,000. Rents are usually $100 to $400 per month.

In most cases, when you rent a mobile device, ownership will transfer to you after 13 months.

Medicare will not cover a wheelchair or scooter that you recently purchased or started renting because you are not happy with it.

“If you have a chair that doesn’t fit you well and you’re not comfortable with it but Medicare has already paid for it, they won’t give you another one for five years,” he says. Paul Laneaccess expert and technology lead for the United Spinal Association’s Tech Access Initiative.

Medicare has added benefits for wheelchairs

Last year, Medicare expanded its coverage of wheelchairs to include power wheelchairs. This feature allows users to easily reach countertops and cabinets.

Chiquita Brooks-LaSure, Centers for Medicare and Medicaid Services (CMS) Administrator, said: “Medicare’s landmark decision on chair lift is an important step forward that will improve quality of life for many people who rely on this technology. .

You will need to be evaluated by a qualified medical practitioner to qualify for a booster seat benefit.

The Independence Through Enhancement of Medicare and Medicaid (ITEM) A coalition of groups such as the Medicare Rights Center and the United Spinal Association is calling for Medicare to re-introduce wheelchair support.

“Standing legs can reduce stomach ulcers and increase bowel and bladder function,” says Lane.

CMS said it plans to consider covering them in the future.

Where you can find wheelchairs and scooters

In order to buy or rent a wheelchair or scooter and be reimbursed by Medicare, you must go to a regular medical equipment provider that accepts Medicare. You can find them near you at Medicare.gov website.

Don’t buy measles from a drug store or grocery store because it’s good and you think the store has Medicare certification. “If you go to a corner pharmacy in a remote area, I doubt they’re licensed,” says Omdahl.

Be careful with the nomenclature: A provider who is eligible for Medicare but does not take it work they may pay you more for a wheelchair or scooter than Medicare allows.

Medicare Advantage Rules

Medicare Advantage plans from private insurers (which are separate from Medicare) have their own wheelchair and scooter dealer networks and their own equipment regulations.

“I found one Medicare Advantage insurance that will transfer ownership of the wheelchair to the user after 13 months, a second that will transfer certain items and not transfer no matter how much you pay,” says Omdahl.

Start the review

Before you buy or rent a wheelchair or scooter, your doctor or equipment dealer should visit your home to make sure you can use it there.

A regular medical equipment provider can refer an Assisted Technology Professional (ATP) to evaluate and determine which seat or scooter equipment you need and which Medicare will approve.

“They know better. They’ll say, ‘Medicare won’t pay for that. Medicare won’t pay for this.’ They guide you along the way,” says Lane.

Narrow domestic problems

A home inspection is very important before moving in a wheelchair because some models are too wide to fit in the doorway.

“I had a chair five or six years ago and it was too big and difficult to fit in different doorways in my house,” says Lane. “I can knock down a lot of walls.”

Omdahl remembers when she was a home care nurse helping a woman with a broken hip who had a wheelchair that wouldn’t fit in her bedroom door. Omdahl said: “I moved the bed to the door and taught the woman to stand up and jump on her bed.

The United Spinal Association’s website is here user reviews thousands of chairs. You can search by model, manufacturer or brand.

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