WheelchairsMobility Devices

Wheelchairs are covered as durable medical equipment under Medicare Part B. If your doctor prescribes a wheelchair for you to use in your home, then Medicare will cover 80 percent of the cost. That leaves you to pay 20 percent after your deductible for the year has been met. Your doctor and supplier must be enrolled in Medicare for the equipment to be covered.

Medicare may pay only for you to rent a wheelchair — not buy one — because a wheelchair is a more expensive and substantial purchase than other common equipment. Medicare typically requires beneficiaries to rent and not purchase items that are considered DME.

But any repairs or replacement parts that you may need will be covered by Medicare only if you own the equipment, while costs for rented items will fall to the supplier. Medicare often pays for equipment like wheelchairs to be rented for up to 13 months.

If you are prescribed a wheelchair to use in your home, you may want to look into various home modifications that can prevent falls and accidents. Past studies have shown that these modifications lead to fewer injuries among wheelchair users.

Scooters are covered as DME if they are prescribed for use in your home by a doctor. Medicare will also help pay for a power wheelchair if it is deemed medically necessary and you meet certain conditions.

A power wheelchair is essentially an electric wheelchair and is meant for people who don’t have the strength or mobility to safely use a manual wheelchair or steer a scooter. In addition to a written prescription, you also have to go through a face-to-face examination before Medicare will help pay for a power wheelchair.

These 3 or 4 wheeled devices offer a user basic motorized mobility but with very limited features and customization – one size fits all. To qualify for a Group 1 device, an individual must be able to transfer on and off the unit. Their arm strength, mobility and coordination must be sufficient to control the tiller style control and trunk stability must be ample to sit without any type of external support. The longer wheel base of scooters necessitates a greater turning radius and thus more room is required for maneuverability (versus the devices described below). This can make their use in the home (particularly the bathroom) challenging.

Group 2 PWCs offer improved mobility assistance over Group 1 POV’s in addition to a host of other potentially necessary features. These include rehab style seating (custom seat and back cushions) versus a simple captain’s style seat; power seat functions (described below) to help with positioning and expanded usability; access to alternative controllers / joysticks; and the ability to mount a ventilator. Qualifying for a Group 2 device would be based upon meeting the basic requirements for a PMD and a demonstration that a Group 1 device would be insufficient.

Group 3 PWCs also offer improved mobility assistance but with attention to the specific needs of their full time users. Group 3 PWCs are intended for individuals living with more complex physical needs secondary to neurological, myopathic or congenital skeletal deformities. Examples include ALS, cerebral palsy, stroke, multiple sclerosis, spinal cord injury, muscular dystrophy, polio, spina bifida. In addition to the features available with Group 2 PWCs, Group 3 PWC’s offer access to upgraded drive control systems for individuals not able to use their hand for traditional joystick use; their suspension systems are designed to reduce vibration; their daily range of use (distance) is almost double that of a Group 2 PWC; they can climb over greater height obstacles / thresholds; and they offer improved stability to the user with traversing inclines and declines. All important features for full time users, with greater physical challenges, engaged in community based activities. Qualifying for a Group 3 device would be based upon meeting the basic requirements for a PMD and a demonstration that a Group 2 device would be insufficient.