For many seniors, the most difficult part of a serious injury or illness isn’t treatment or recovery. Rather, it’s adjusting to a new way of life with limited mobility. There are a wide range of conditions that can cause mobility limitations, from strokes to arthritis to joint challenges and more.
The loss of mobility can often feel like a loss of independence. It doesn’t have to be that way though. There are a wide range of mobility aids that can help a person regain their independence even if they have difficulty walking, climbing stairs, or simply getting around the house.
Many of these aids can be costly, however. Items like a motorized scooter, a stair lift, or even safety improvements to a bathroom can quickly add up. If you’re a retiree with limited income, it may be challenging to pay for those items out-of-pocket.
The good news is that Medicare will cover some types of mobility aid equipment. However, the items in question have to meet several qualification standards. There are other pieces of equipment that are never covered by Medicare, even if you and your doctor deem them critical to your care and recovery. Below are some guidelines to help you determine whether your equipment will be covered.
What Is Covered By Medicare
If you’re like many retirees, you may assume that Medicare pays for mobility aid items. That assumption is partially true. Medicare Part B does cover something called “durable medical equipment.” However, the equipment must meet certain criteria. If the equipment is eligible, Medicare usually covers 80 percent of the cost while the patient has to pay the remainder out-of-pocket.
To qualify as eligible durable medical equipment, the item must meet the following standards:
It’s durable. This means that it must be something that you will use over and over again for an extended period of time. Items that are disposable after one use or are only needed for a short period are not eligible. Generally, Medicare expects “durable” items to have a useful life of at least three years.
It’s medically necessary. The item must by deemed medically necessary by your doctor. Usually Medicare will require a written letter from your doctor explaining why the item is necessary.
It’s not commonly used by health individuals. This is a tricky, but important requirement. If the item is commonly purchased even if it’s not medically necessary, it likely won’t be covered. For instance, a power wheelchair is usually only used by those who have mobility limitations. On the other hand, a large soaking bathtub could be purchased for any number of reasons, meaning it likely won’t be covered by Medicare.
It will be used in your home. Medicare only covers equipment that will be used in your home. If you will use your scooter to navigate inside your home, that improves the odds that it will be covered. If you will only use the scooter when you are shopping or doing other outside the home activities, it’s less likely to be covered.
Using this criteria, it’s easy to see how many types of healthcare and mobility equipment may qualify for coverage. Everything from scooters to lifts to wheelchairs to some types of beds could be covered as durable medical equipment.
What Is Not Covered
Basically anything that doesn’t meet the criteria listed above is not covered by Medicare. That often includes things that are installed in the home for safety or comfort. For example, grab bars, cushions, elevated seats, and more often are not covered because of the “medically necessary” criteria. They may make life easier for you, but they aren’t considered vital to your treatment or recovery.
Home remodels also aren’t covered by Medicare. Yes, a roll-in safety tub may make it easier for you to bathe. However, in Medicare’s view, that remodel isn’t considered medically necessary. Also, many people who aren’t injured or ill perform bathroom remodels, so Medicare is often concerned that it would be paying for remodeling work that isn’t relevant to your condition.
Not sure whether your needed items will be covered? One of the best ways to find out is to work with a dealer or retailer that is Medicare-qualified. They will understand the eligibility standards and can help guide you through the process. Med Mart is a dealer of Medicare durable equipment. Contact us today so we can help you live a more mobile, independent, and enjoyable life.