Electric Wheelchairs and Medicare - What You and Your Family Need to Know

It's been an interesting few years for those that follow the relationship between the electric wheelchair industry and Medicare. Fifteen years ago, chances are you never heard of electric wheelchairs. Although they have been around for longer than that, they were not readily available until the past 10 to 12 years.

That's when companies like The Scooter Store and Hoveround began to market the wheelchairs nationally in the same manor that diabetic supply companies promoted diabetic medical supplies that were Medicare covered. When these companies began their national advertising campaigns for electric wheelchairs, the demand for the equipment nearly tripled in under three years (from 1999 to 2002). The Medicare expenditures for these wheelchairs increased by a whopping $556 million over this time period.

This does not, however, mean that the increase has been a bad thing for Medicare. According to a 2005 independent study, the electric wheelchair industry actually saves Medicare billions annually because Medicare people who receive electric wheelchairs tend to be healthier overall and suffer fewer injuries. The study found that the rate of people with broken hips was significantly lower when individuals had electric wheelchairs.

Over the past three to five years, the electric wheelchair industry and Medicare have battled over who should qualify for this type of medical equipment and how much Medicare should pay for those that receive it. Last year, Medicare finally released what seems to be the new directive for pricing and eligibility for electric wheelchairs. Below is a brief overview.

Medicare Electric Wheelchair Eligibility

To be eligible to receive an electric wheelchair through Medicare a person must have what is considered a daily living activity need for it and that need must be inside the home. Medicare currently does not covered electric wheelchairs or scooters for people who exclusively need them outside the home.

Daily living activities include feeding, bathing, dressing, toileting and so on. What does this really mean? It means that a person must need the chair to get around inside the home for at least one of these activities. Medicare will only consider the person eligible if he or she cannot conduct these specific daily living requirements with the use of a manual wheelchair, cane, walker or freely.

How Much will an Electric Wheelchair Cost?

The pricing for electric wheelchairs differs throughout the country. Whatever the allowable price is in your area, Medicare will typically pay for 80 percent of the cost. The remaining copayment may be picked up by your supplemental Medicare insurance if you have one. If you do not, you are responsible for the remaining 20 percent (normally between $1,200 and up).

How Do I Get an Electric Wheelchair?

You need to first ask your doctor if you are eligible and if you meet the minimum Medicare requirements. If your doctor says you do, then contact a medical equipment supply company (either a local one or a national one like The Scooter Store or Hoveround). The medical equipment supply company will direct you what to do next.