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People with mobility problems, especially older adults, have two main concerns about not being able to get around easily or safely—they will suffer a fall or they'll lose their independence if they aren't able to care for themselves. These are very real concerns. According to the Centers for Disease Control and Prevention, fall occur in one out of three adults age 65 and older, and many of those result in serious injury. As you become less mobile, you often become more dependent on family or friends.
If your decreased mobility is significant enough that you need help with daily living activities within your home, you may want to get a mobility product like a wheelchair or electric scooter. In order to find out what is best for you, you'll need to have an assessment by your doctor. This is especially important if you get it through your Medicare coverage.
Have an Assessment
Your doctor can tell you what is involved in being evaluated for a mobility aid. During your exam, he will evaluate the following:
- Your ability to walk without any support: if you've reached the point where you are not able to walk by yourself without assistance, he will know that you need a mobility aid.
- Your body strength: If you are not able to stand or hold yourself upright for any length of time, you will not be able to use a four-pronged walker or rolling walker.
- Your posture and balance: Using a power mobility scooter or manual wheelchair requires some degree of balance and the ability to sit up straight without support.
- Your upper-body strength: Like posture and balance, in order to use a manual wheelchair or scooter, you will need to have enough upper-body strength.
- Hand and arm strength: A scooter or manual wheelchair requires that you have enough strength to squeeze hand controls, brakes, or wheel yourself in a chair.
After your assessment is complete, your doctor will discuss your options with you. If he has determined that you need an electric (also called power) wheelchair, he will write his recommendation. This is like an order or prescription, and you will need this in to begin looking for your power chair.
What Do You Need in an Electric Wheelchair?
Now that you have your doctor's recommendations, including specifics like what type of controls you need for your wheelchair, you can determine what kind of chair you need.
- Do you plan to use your wheelchair outdoors or mainly indoors? Different models of power wheelchairs are made to be used mostly indoors, outside, or both. Most models are able to go either place, but some features are specific to outdoor use, especially if you will be on rough surfaces. Some chairs have a tighter wheel-radius so they are easier to maneuver in small, tight indoor spaces.
- What are your functional limitations? If you need additional support from the seat or back of your electric wheelchair, there are features available. If you have very limited arm mobility, you may not be able to operate a joystick control. There are other control options—for example, a "sip and puff" control allows you to inhale and exhale into a tube to control the chair.
Does Medicare cover the cost of my electric wheelchair?
Most of the cost of your power wheelchair is covered under your Original Medicare Part B coverage. But you must meet all the criteria:
- Your doctor must write an order for your electric wheelchair. A face-to-face examination is required and the order must inform Medicare why you need the mobility product.
- Your wheelchair must be medically necessary.
- You must be able to operate the wheelchair. Your doctor's orders must say that you are physically capable of operating the chair.
- You are unable to do the normal activities of daily living. This includes bathing, dressing, getting out of bed or going to the bathroom.
- You're able to safely operate the wheelchair. You can get on and off the wheelchair or have someone with you that can help.
- You must be able to use the equipment in your home. You have clear pathways in your house so the wheelchair will not be blocked.
Medicare Part B will pay up to 80 percent of the cost of the electric wheelchair from a Medicare-approved provider. You will have to meet your yearly deductible.
Recent changes to Medicare coverage for electric wheelchairs
There have been several recent changes to Medicare coverage for "Durable Medical Equipment," which includes medical supplies and electric wheelchairs. It's important that you read and understand these changes.
1. Competitive bidding
In an effort to cut costs, Medicare began to implement what is called "competitive bidding" at the beginning of 2011. The program requires providers and suppliers of Durable Medical Equipment to submit competitive bids for their products in order to stay or become Medicare-approved. Under this new rule, you must use Medicare-approved suppliers, or Medicare will not pay for the item.
This rule is currently effective in several metropolitan areas in the following states: CA, FL, IN, KS, KY, MO, NC, OH, PA, SC, and TX. If you live in one these areas—or get Durable Medical Equipment while visiting one of these areas—you will have to use a supplier that participates in the competitive bidding program. Beginning in 2012, the program is scheduled to expand to an additional 91 metropolitan areas, and by 2016, it will be effective in regions in all 50 states.
It's important to be sure that any supplier of electric wheelchairs that you select is still or has become a Medicare-approved provider. If you have questions about covered suppliers, go to www.medicare.gov/supplier to search for Medicare-approved suppliers or call 1-800-MEDICARE (1-800-633-4227).
2. New rental requirements
In the past, Medicare beneficiaries had the option to either purchase or rent their electric wheelchairs. However, as of January 1, 2011, Medicare beneficiaries can only rent the equipment over a 13-month period. Once the 13-month rental period is complete, the equipment supplier will transfer ownership to the beneficiary.
Under these new guidelines, you will be billed thirteen times instead of once to satisfy your Medicare coinsurance for the electric wheelchair. For example, if your coinsurance amount is $200, you will pay about $15 a month for 13 months rather than paying the entire amount in one lump payment.
It's important to know that these new rental requirements do not apply to standard electric wheelchairs furnished in the competitive bidding areas listed above. They also do not apply to complex, rehabilitative wheelchairs, such as those with power seating systems or special controls.
3. Stricter evaluation guidelines
There are also now much stricter guidelines for doctors and providers who evaluate your need for a mobility aid. These evaluations have always been face-to-face for Medicare to approve an electric wheelchair, but now these evaluations are even more lengthy and detailed.
Adapting to Your New Electric Wheelchair
Although your electric wheelchair will provide you mobility and independence, give yourself time to adapt to using your new equipment. There will be a learning curve. Don't hesitate to call the supplier if you have any questions or are having any problems with your chair.
There are many accessories available to customize your wheelchair. These include bags that allow you to transport items, mirrors for safety and other options. These are not usually covered by your Medicare plan, but may be just what you need to be more comfortable in your new wheelchair.
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