Whether from illness, injury, or age, it’s common for many individuals to need mobility devices and home medical equipment for their everyday lives. 

You may have the option of two different “pathways” for getting your medical mobility device: 

• Insurance Approval: Gain approval from your insurance company (such as Medicare), which will then partially or fully cover the cost of the equipment.
• Self-Pay: Pay in full for the mobility device yourself. 

While it may seem like a “no-brainer” to go through insurance for mobility devices, insurance isn’t always the best option. 

While insurance-approved devices can alleviate some of the financial burden, there are often complicated approval processes, limited customization available, and other drawbacks to consider. 

Let’s go over some of the most important “pros and cons” of insurance vs self-pay for mobility devices, so that you can make an informed decision for yourself or a loved one.

The biggest benefit is of course- cost! 

If a mobility device is deemed medically necessary, Medicare will often partially or fully pay for the mobility equipment (Often 80% of the full price). 

If you’re working within a tight budget, this can be a huge help in receiving necessary mobility assistance. 

Insurance coverage like Medicare usually ensures that you can obtain the necessary mobility tools (like wheelchairs, hospital beds, etc.) to sustain your quality of life. However, the insurance approval process is complicated, takes a long time, and has considerable limitations.

The insurance approval process may be challenging if you’re not a fan of paperwork, complicated documentation, and long waiting periods. 

To receive insurance approval for a mobility device, you’ll need to do the following: 

• Research: Look into the specific documentation needed for your mobility device.
• Documentation: Meet with your doctor to discuss your mobility needs. If your doctor determines you would benefit from a mobility device, they can submit a request to Medicare to obtain prior authorization.
• Waiting Period: After submitting the necessary documentation, you will have to wait several weeks for Medicare to review your request.
• Possible Denial: If your claim is denied, you'll need to go through the appeals process, which can be frustrating and time-consuming.
• Supplier Selection: If approved, you and your doctor can select a supplier for your device that is enrolled in Medicare and meets your requirements.
• Delivery: Wait for delivery of your insurance-approved mobility device

Overall, this can be a time-consuming process, and it can take up to 6 months for your mobility device to be delivered to your home. 

Medicare’s coverage is generally limited to equipment used “in the home”. For active individuals who may want to purchase an outdoor mobility scooter, wheelchair vehicle lift, and wheelchair ramps, insurance coverage may not be an option. 

Medicare typically only covers very basic models of wheelchairs and scooters. If you’re looking for specialized features, adjustable seating, a modern design, customization options, and more, you may want to explore self-pay options. 

In comparison to the complicated insurance approval process, self-pay is a breeze. Simply select which mobility device you’d like (either through an in-store or online retailer), then order it! You can start using your mobility device within days. 

If Medicare-approved mobility devices are basic and limited, self-pay is the opposite! You can scroll through thousands of different models from different suppliers, choose specific features, select colors, and more. With self-pay, you’re almost guaranteed to find a device that’s perfectly suited to your needs. 

For example: At Med Mart, we have over 250 different options available for mobility scooters alone! Filter by portable models, 3-wheels, 4-wheels, all-terrain scooters, drive range, lighting packages, and so much more. 

Sometimes, self-paying for mobility equipment can even help with Medicaid eligibility. You can lower your documented assets by “spending down” your savings on necessary mobility equipment. This helps you become eligible for Medicaid more quickly while improving your health and quality of life. 

Self-paying for mobility equipment requires an upfront investment. Because insurance is not partially paying for your equipment, you are responsible for the total cost on your own. 

If you’re having trouble paying for the full cost of the mobility device upfront, many retailers will offer payment plans. 

You may be wondering– am I even eligible for insurance to cover mobility equipment for me? 

Each individual mobility device has different eligibility requirements that need to be met to be covered by Medicare. This can vary depending on features as well– a power wheelchair has different requirements than a standard manual wheelchair. 

If you’re looking for information on a particular mobility device, we recommend visiting Medicare’s coverage search page. 

Below are some common examples of mobility equipment, and what to expect from Medicare eligibility requirements.

Medicare Part B covers wheelchairs if prescribed by a doctor and deemed medically necessary. This could be prescribed if you are unable to walk long distances, have broken bones or neurological issues, are unable to use other mobility devices (like a cane or walker), and more. If a power wheelchair is requested, you must demonstrate that it’s difficult to operate a standard manual wheelchair by yourself. 

Surprisingly, most of the time Medicare does not cover wheelchair ramps for your home. While occasionally Medicare Advantage plans may offer coverage for home ramps as part of add-on benefits, most of the time self-pay is recommended. 

Reach more about insurance coverage for home wheelchair ramps. 

Like wheelchairs, hospital beds can be prescribed and covered by Medicare. Examples of conditions that may meet medical necessity include: a condition that requires specific positioning or head elevation, mobility limitations, safety risks, spinal cord injuries, and more. 

When it comes to the best medical device payment methods, there’s no one-size-fits-all solution. Take time to figure out your budget, what features you’re looking for, how soon you’d like to start using the mobility device, and other questions before deciding whether to self-pay or use Medicare. 

No matter which process you choose, the most important thing is that you or a loved one is able to get the equipment they need for a happier, more fulfilled, healthy lifestyle. 

My passion for movement began when I temporarily lost my mobility in a severe car accident. Recovery led me down a career path in rehabilitation. I graduated from the University of Dayton with a Doctorate in Physical Therapy, then practiced as a PT for 11 years before becoming an ATP. My experience has molded me into an expert in biomechanics, kinesiology and positioning. This journey has allowed me to have a very rewarding career in helping assist people to return to an independent and fulfilling lifestyle. As a result of my physical therapy background, it is not my intention to inhibit improvements with strength through the use of a chair, but to assist individuals by improving their quality of life while continuing to progress towards movement goals.