Does Medicare Cover Mobility Devices?

Medicare provides coverage for mobility devices, which fall under the category of durable medical equipment (DME). This support helps beneficiaries obtain essential items like wheelchairs, scooters, and walkers when medically necessary. Understanding the specific requirements and processes involved is important for individuals seeking to access these benefits. The coverage aims to ensure that those with qualifying medical conditions can maintain their mobility and independence within their homes.

Understanding Medicare Coverage for Mobility Devices

Medicare defines durable medical equipment (DME) as reusable medical equipment prescribed by a healthcare professional for frequent or prolonged use in the home. Mobility devices are included in this classification. For equipment to qualify as DME, it must be durable, meaning it can withstand repeated use, serve a medical purpose, and have an expected lifespan of at least three years.

Medicare Part B (Medical Insurance) covers medically necessary DME. This includes a range of mobility aids such as manual wheelchairs, power wheelchairs, scooters, walkers, crutches, and canes. Accessories and customizations for these devices, like specialized cushions or positioning equipment, may also be covered if medically necessary and tied to a specific medical condition.

A fundamental requirement for coverage is medical necessity. A doctor must certify that the device is necessary for the patient’s medical condition, confirming it will be used to treat an illness or injury and utilized primarily in the home. The device must address a health condition that significantly limits mobility within the home, making it difficult to perform daily activities even with other aids like canes or crutches.

A written order or prescription from a qualified healthcare provider is required for Medicare to cover a mobility device. This order must specify the exact device needed, the diagnosis, and the medical justification for its use. The provider must conduct a face-to-face examination no more than 45 days before writing the prescription for certain items, such as power wheelchairs or scooters. The order should also confirm the equipment is for use in the beneficiary’s home.

Steps to Obtain a Covered Mobility Device

Obtaining a Medicare-covered mobility device begins with a thorough consultation with a healthcare provider. During this visit, the provider will assess the medical condition, determine specific mobility limitations, and establish the medical necessity for the equipment. The provider will then issue a detailed written order or prescription, a required document for Medicare purposes. This order must include the diagnosis, the type of device prescribed, and a clear explanation of why the device is medically necessary for use in the home.

After securing the necessary prescription, find a Medicare-approved supplier. Beneficiaries can locate these suppliers by using online tools like the supplier directory on Medicare.gov or by calling 1-800-MEDICARE. It is important to choose a supplier that is enrolled in Medicare and, for Original Medicare beneficiaries, one that “accepts assignment.” A supplier who accepts assignment agrees to accept Medicare’s approved amount as full payment, limiting the beneficiary’s out-of-pocket costs to the deductible and coinsurance. If a supplier does not accept assignment, they may charge more than the Medicare-approved amount, and the beneficiary could be responsible for the difference.

Medicare has specific rules regarding whether a mobility device is rented or purchased. Many types of DME, including some manual and power wheelchairs, are initially rented. Original Medicare typically covers 80% of the monthly rental fee for 13 months, after which the beneficiary owns the equipment. Other items, such as walkers and canes, are often purchased directly. The decision to rent or buy can depend on the specific item and Medicare’s classification.

For some high-cost mobility devices, such as certain power wheelchairs and scooters, Medicare may require prior authorization. This process involves the supplier submitting documentation to Medicare for approval before the device is provided. Prior authorization helps ensure Medicare coverage, payment, and coding rules are met. The supplier is responsible for submitting the claim to Medicare on the beneficiary’s behalf once the device is obtained.

Your Financial Responsibility

Beneficiaries incur financial responsibility for Medicare-covered mobility devices. The first step is meeting the annual Medicare Part B deductible. Medicare will not begin to pay its share until this deductible has been satisfied.

After the Part B deductible is met, Medicare typically pays 80% of the Medicare-approved amount for durable medical equipment. The beneficiary is responsible for the remaining 20% coinsurance. This coinsurance amount is a percentage of the Medicare-approved cost, not the supplier’s initial charge.

Using a supplier who does not accept assignment can lead to higher out-of-pocket costs. These suppliers are not bound by Medicare’s approved amount and can charge more. Beneficiaries may pay the full amount upfront and then submit a claim to Medicare for reimbursement. They will receive 80% of the Medicare-approved amount, but remain responsible for the 20% coinsurance and any amount above Medicare’s approved charge.

Medicare also provides coverage for repairs and replacements of mobility devices. Repairs for covered equipment are generally covered. Replacements are covered if the device is lost, stolen, or irreparably damaged, provided there is proof of the damage or theft. If a device is worn out from day-to-day use, Medicare will only replace it if it has been in the beneficiary’s possession for its entire useful lifetime, which is generally considered to be five years for most equipment. A new doctor’s order is required for replacements to confirm continued medical necessity.