Impaired mobility is a common concern for older adults.
Falls are the leading cause of injury for people over 65, and mobility issues can significantly impact quality of life.
Many people begin to experience physical limitations in their 60’s, such as muscle weakness, balance problems, pain, or visual impairments. These issues only increase as people age. Which is why your doctor may be willing to prescribe or sign a letter of medical necessity to help you get a power mobility device, or PMD.
These power mobility devices (PMDs) include power wheelchairs and power operated vehicles, or scooters.
Assistive devices can be a tremendous help for older adults and greatly enhance their quality of life. POVs help seniors move around the house and stay active in their communities.
But these devices are very expensive!
An electric scooter can range from $1000-$5000, and a specialized electric wheelchair can cost up to $15,000 or more!
Fortunately, it’s possible to obtain a PMD through Medicare. This article will explain how, and discuss ways to minimize your out-of-pocket costs.
You can also contact a Personal Benefits Manager at any time to answer any questions you may have, and help guide you through the process.
Learn More: Why You Should Use an Independent Agent to Buy Your Medicare Plan
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Other Options
Medicare Advantage Plans are an alternative to Original Medicare.
Advantage plans are administered by private insurance companies that are approved by Medicare. They establish their own rules within Medicare guidelines, so their coverage for Part A and Part B services may be different.
You can’t add a Medicare supplement (or Medigap) plan to pay out-of-pocket costs like you can with Original Medicare. But an Advantage plan may cover dental, hearing and vision services, which Original Medicare doesn’t.
Medicare Advantage plans have different rules and coverage amounts for durable medical equipment (DME) like electric wheelchairs and scooters compared to Original Medicare.
Here’s the basic process for obtaining an electric wheelchair with a Medicare Advantage plan:
- Consult Your Doctor – The first step is to schedule an appointment with your doctor to discuss the medical necessity of an electric wheelchair. If your doctor agrees, they will provide a prescription for a specific type of wheelchair.
- Review Your Medicare Advantage Plan Coverage – Every Medicare Advantage plan has its own coverage details and network of healthcare providers and DME suppliers. Here’s how to find the specifics of your plan:a. Carefully review your plan documents (often called Evidence of Coverage or EOC) to understand coverage details for DME, including wheelchairs and scooters. Look for sections on durable medical equipment, home medical equipment, or mobility devices.
b. You can also contact your Medicare Advantage plan provider directly by phone or through their online member portal. They can explain your coverage details for wheelchairs and the specific requirements for getting one. - Find a DME Supplier in-Network – Medicare Advantage plans typically require you to use DME suppliers within their network to ensure coverage. Your plan provider can give you a list of in-network suppliers or might have an online search tool.
- Work with the DME Supplier – Once you’ve found a qualified DME supplier, they will help you choose an electric wheelchair that meets your needs and is covered by your Medicare Advantage plan. The supplier will also handle the process of getting pre-approval from your plan, if required.
- Pre-Approval Process (Possible) – Some Medicare Advantage plans may require pre-approval for power wheelchairs before they’ll provide coverage. The DME supplier will typically handle this by submitting the doctor’s prescription and any other necessary documentation to your plan for review.
Costs for Medicare Advantage Customers
This is where it gets a bit complex.
Medicare Advantage plans have varying structures for covering DME costs. Here’s what you might encounter:
- You might have a fixed copayment amount for your electric wheelchair, regardless of the total cost.
- Your plan might have a coinsurance percentage. This means you’d be responsible for a percentage of the approved cost after Medicare Advantage pays its share.
- Some plans may have a deductible that you’d need to meet before coverage kicks in for the wheelchair.
It’s difficult to predict the exact out-of-pocket costs upfront because they depend on your specific Medicare Advantage plan. You would need to carefully review your plan documents and ask your plan provider questions about coverage details, pre-approval processes, and potential out-of-pocket costs for a power wheelchair.
If you’re considering switching Medicare Advantage plans, compare coverage details for DME, specifically wheelchairs, among different plans during the annual enrollment period.
Learn More: Don’t Buy a Zero-Premium Medicare Advantage Plan Before Reading This!
Cost Comparison of Electric Wheelchair with Different Medicare Options
Here’s a breakdown of estimated out-of-pocket costs for a $4,000 electric wheelchair under the different Medicare options presented so far:
Scenario 1: Original Medicare – No Supplemental Insurance
- Let’s assume Medicare approves coverage for the full cost: $4,000
- You’d pay the deductible ($240) before Medicare starts covering anything.
- You’d be responsible for 20% coinsurance on the approved amount (after the deductible). So, on an approved cost of $3,760 ($4,000 – $240), you can expect to pay $752.
- Total Out-of-Pocket Cost: $240 (deductible) + $752 (coinsurance) = $992.
Scenario 2: Medicare Advantage Plan (Assuming Coverage)
- Important Note: Out-of-pocket costs for Medicare Advantage plans can vary significantly depending on the specific plan. Here’s a general comparison:
- The plan might have a copayment for the wheelchair, resulting in a fixed out-of-pocket cost regardless of the total price (exact amount depends on the plan).
- The plan might have coinsurance, where you pay a percentage of the approved cost after meeting a deductible (similar to Original Medicare, but the percentage and deductible could vary by plan).
- Due to the variability, it’s difficult to pinpoint an exact cost. Still, it’s possible the out-of-pocket expense could be lower than $880 seen in Scenario 1, especially with plans that have copayments. However, it could also be higher if the plan has a high deductible and coinsurance structure.
Scenario 3: Medigap Plan A
- Medigap Plan A focuses on covering the deductible but not coinsurance.
- Plan A would cover the $240 deductible.
- You’d still be responsible for the 20% coinsurance on the approved amount ($640 in this example).
- Total Out-of-Pocket Cost: $640 (coinsurance)
Scenario 4: Medigap Plan G
- Medigap Plan G is one of the most comprehensive plans, covering both the deductible and coinsurance.
- Plan G would cover both the $240 deductible and the 20% coinsurance ($640).
- Total Out-of-Pocket Cost: $0 (Plan G covers everything in this scenario)
Summary Table:
| Scenario | Description | Out-of-Pocket Cost |
|---|---|---|
| Medicare Only | No supplemental insurance | $992 |
| Medicare Advantage | Varies by plan, potentially lower than $880 | Varies |
| Medigap Plan A | Covers 100% of coinsurance but not deductible | $760 |
| Medigap Plan G | Covers 100% of coinsurance | $240 |
Other Options
Medicare Advantage Plans are an alternative to Original Medicare.
Advantage plans are administered by private insurance companies that are approved by Medicare. They establish their own rules within Medicare guidelines, so their coverage for Part A and Part B services may be different.
You can’t add a Medicare supplement (or Medigap) plan to pay out-of-pocket costs like you can with Original Medicare. But an Advantage plan may cover dental, hearing and vision services, which Original Medicare doesn’t.
Medicare Advantage plans have different rules and coverage amounts for durable medical equipment (DME) like electric wheelchairs and scooters compared to Original Medicare.
Here’s the basic process for obtaining an electric wheelchair with a Medicare Advantage plan:
- Consult Your Doctor – The first step is to schedule an appointment with your doctor to discuss the medical necessity of an electric wheelchair. If your doctor agrees, they will provide a prescription for a specific type of wheelchair.
- Review Your Medicare Advantage Plan Coverage – Every Medicare Advantage plan has its own coverage details and network of healthcare providers and DME suppliers. Here’s how to find the specifics of your plan:a. Carefully review your plan documents (often called Evidence of Coverage or EOC) to understand coverage details for DME, including wheelchairs and scooters. Look for sections on durable medical equipment, home medical equipment, or mobility devices.
b. You can also contact your Medicare Advantage plan provider directly by phone or through their online member portal. They can explain your coverage details for wheelchairs and the specific requirements for getting one. - Find a DME Supplier in-Network – Medicare Advantage plans typically require you to use DME suppliers within their network to ensure coverage. Your plan provider can give you a list of in-network suppliers or might have an online search tool.
- Work with the DME Supplier – Once you’ve found a qualified DME supplier, they will help you choose an electric wheelchair that meets your needs and is covered by your Medicare Advantage plan. The supplier will also handle the process of getting pre-approval from your plan, if required.
- Pre-Approval Process (Possible) – Some Medicare Advantage plans may require pre-approval for power wheelchairs before they’ll provide coverage. The DME supplier will typically handle this by submitting the doctor’s prescription and any other necessary documentation to your plan for review.
Costs for Medicare Advantage Customers
This is where it gets a bit complex.
Medicare Advantage plans have varying structures for covering DME costs. Here’s what you might encounter:
- You might have a fixed copayment amount for your electric wheelchair, regardless of the total cost.
- Your plan might have a coinsurance percentage. This means you’d be responsible for a percentage of the approved cost after Medicare Advantage pays its share.
- Some plans may have a deductible that you’d need to meet before coverage kicks in for the wheelchair.
It’s difficult to predict the exact out-of-pocket costs upfront because they depend on your specific Medicare Advantage plan. You would need to carefully review your plan documents and ask your plan provider questions about coverage details, pre-approval processes, and potential out-of-pocket costs for a power wheelchair.
If you’re considering switching Medicare Advantage plans, compare coverage details for DME, specifically wheelchairs, among different plans during the annual enrollment period.
Learn More: Don’t Buy a Zero-Premium Medicare Advantage Plan Before Reading This!
Cost Comparison of Electric Wheelchair with Different Medicare Options
Here’s a breakdown of estimated out-of-pocket costs for a $4,000 electric wheelchair under the different Medicare options presented so far:
Scenario 1: Original Medicare – No Supplemental Insurance
- Let’s assume Medicare approves coverage for the full cost: $4,000
- You’d pay the deductible ($240) before Medicare starts covering anything.
- You’d be responsible for 20% coinsurance on the approved amount (after the deductible). So, on an approved cost of $3,760 ($4,000 – $240), you can expect to pay $752.
- Total Out-of-Pocket Cost: $240 (deductible) + $752 (coinsurance) = $992.
Scenario 2: Medicare Advantage Plan (Assuming Coverage)
- Important Note: Out-of-pocket costs for Medicare Advantage plans can vary significantly depending on the specific plan. Here’s a general comparison:
- The plan might have a copayment for the wheelchair, resulting in a fixed out-of-pocket cost regardless of the total price (exact amount depends on the plan).
- The plan might have coinsurance, where you pay a percentage of the approved cost after meeting a deductible (similar to Original Medicare, but the percentage and deductible could vary by plan).
- Due to the variability, it’s difficult to pinpoint an exact cost. Still, it’s possible the out-of-pocket expense could be lower than $880 seen in Scenario 1, especially with plans that have copayments. However, it could also be higher if the plan has a high deductible and coinsurance structure.
Scenario 3: Medigap Plan A
- Medigap Plan A focuses on covering the deductible but not coinsurance.
- Plan A would cover the $240 deductible.
- You’d still be responsible for the 20% coinsurance on the approved amount ($640 in this example).
- Total Out-of-Pocket Cost: $640 (coinsurance)
Scenario 4: Medigap Plan G
- Medigap Plan G is one of the most comprehensive plans, covering both the deductible and coinsurance.
- Plan G would cover both the $240 deductible and the 20% coinsurance ($640).
- Total Out-of-Pocket Cost: $0 (Plan G covers everything in this scenario)
Summary Table:
Scenario: Medicare Only
- Description – No supplemental insurance
- Out-of-Pocket Cost – $992
Scenario: Medicare Advantage
- Description – Varies by plan, potentially lower than $880
- Out-of-Pocket Cost – Varies
Scenario: Medigap Plan A
- Description – Covers 100% of coinsurance but not deductible
- Out-of-Pocket Cost – $760
Scenario: Medigap Plan G
- Description – Covers 100% of coinsurance
- Out-of-Pocket Cost – $240
Important Considerations:
This is a simplified example, and actual costs can vary depending on specific circumstances, plan details, and Medicare approvals.
It should also be noted that Medicare Advantage plans can have network restrictions for DME suppliers.
Premiums for Medigap plans can vary depending on factors like age, location, and the specific plan chosen.
Health Savings Accounts Can Help
You can potentially use HSA funds to pay for the deductible and coinsurance associated with an electric wheelchair, and this can save you money on taxes!
Electric wheelchairs are considered qualified medical expenses by the IRS, making them eligible for reimbursement from your HSA. This means you can use your HSA debit card to pay for the deductible and coinsurance associated with a Medicare-approved electric wheelchair.
When you use your HSA funds to pay for qualified medical expenses, the withdrawals are tax-free.
Potential Savings
Let’s say the electric wheelchair costs $4,000, and after getting Medicare coverage, you’re responsible for a $880 deductible and coinsurance. By using your HSA funds to pay the $880, you avoid paying taxes on that money.
Depending on your tax bracket, this could translate to a savings of 10% to 40%!
Note: Be sure to keep all receipts related to your HSA contributions and qualified medical expenses, as well as your doctor’s prescription or letter of medical necessity. That way you will be prepared in case the IRS wants to challenge the expense.
Using HSA funds for a qualified medical expense like an electric wheelchair can be a smart strategy. It allows you to use pre-tax dollars to cover the costs and saves money on taxes.
Possible Tax Deduction
It’s possible that you can deduct out-of-pocket costs for an electric wheelchair on your taxes, directly, even if you don’t have a health savings account.
Deductions are allowed for the portion of medical and dental expenses not reimbursed by insurance. This includes payments for diagnosis, cure, mitigation, treatment, or prevention of disease, and for treatments affecting any structure or function of the body, like electric wheelchairs.
To deduct out-of-pocket costs for an electric wheelchair on Schedule A, your total medical and dental expenses must exceed 7.5% of your Adjusted Gross Income (AGI).
Itemize these deductions on Schedule A (Form 1040) for the tax year the expenses were paid. Include costs not reimbursed by insurance.
For instance, if your AGI is $50,000, the threshold to itemize medical expenses on Schedule A would be $3,750 (7.5% of $50,000). So, only the portion of your electric wheelchair costs that exceed $3,750 would be eligible for deduction.
This might not be a useful strategy for lower-cost equipment, but could be helpful if you ever need a highly specialized electric wheelchair that costs more than $10,000.
Additional Tips
- Rental vs. Purchase – Depending on your situation, Medicare might allow you to either rent or purchase the electric wheelchair. Discuss these options with your supplier to understand what makes the most sense for your needs and how it might affect your costs.
- Supplier Participation – Confirm that suppliers are participating in Medicare and accept assignments to avoid being charged more than the Medicare-approved amount.
- Check Your Plan Annually – Medicare Advantage plans can offer different coverages and costs year-to-year. If you’re enrolled in a Medicare Advantage plan, check its terms annually to understand how they affect your DME coverage.
- Ask for a Detailed Explanation – If you’re unsure about any part of this process or how much you’ll owe, don’t hesitate to ask your healthcare provider, DME supplier, or contact Medicare directly for clarification.
Get a Free Medicare Advantage Quote
Moving Forward
When it comes to obtaining an electric wheelchair or power scooter, Medicare requirements can be complex and confusing.
Original Medicare alone only covers a portion of the costs. But there are ways to get help with the remaining out-of-pocket expenses. MediShare 65+, Medigap, and Medicare Advantage Plans are just a few great options.
A Personal Benefits Manager can assess your situation and find the right plan to help get you the best equipment and healthcare services at the most affordable price.
Don’t stay stuck at home with impaired mobility. Schedule your free consultation today!
For Further Reading: 10 Medicare Mistakes to Avoid When Choosing a Plan|What Are Medicare Excess Charges?|What is the “Maximum Out-of-Pocket” in Medicare Plans?
Leslie Alford is a Personal Benefits Manager at MediGap Advisors. Leslie has a passion for bringing clarity to those confused about Medicare. She is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Leslie on her Bio page.