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
Get a Free Medicare Supplement Quote
Medicare Coverage and Eligibility
Medicare Part B covers power wheelchairs and scooters as durable medical equipment (DME).
They must be considered medically necessary, and prescribed by a doctor to help you perform daily living activities around your home.
After meeting the Part B deductible of $240, you’re then responsible for paying 20% of the Medicare-approved amount.
How to Get Your PMD
- Consult with Your Doctor. Start the process by making an appointment with your doctor to discuss your mobility needs. If your doctor determines a PMD is medically necessary, and that you need it to perform daily activities and move around your home, they must write up a specific order for it.
- Meet the Conditions. Your doctor must submit the order stating your need for a wheelchair or scooter, specifying that you have a health condition that significantly impairs your mobility within your home and that you cannot perform activities of daily living without it. You should also be able to safely operate the device, and your home must accommodate its use.
- Choose a Supplier. Make sure that your equipment supplier is also enrolled in Medicare or your POV won’t be covered.
- Obtain Authorization. For certain types of PMDs, Medicare requires prior authorization. Your supplier and doctor will handle this process and submit the required information. But you must wait for Medicare approval before making the final purchase.
Costs
Generally, you can expect to pay at least the Medicare Part B deductible before your benefits kick in, which as of 2024 amounts to $240.
After that, Part B pays 80% of the cost of purchasing a mobility device. If you don’t have any other coverage in place, such as a Medigap Plan G or the Medi-Share 65+ health sharing plan, you’ll have to pay the 20% copay out of pocket.
Note: The Medicare-approved amount might be less than the actual retail price of the device. You will normally have to pay the difference.
Example:
Assume Medicare approves the full $4,000 cost of a power wheelchair.
Medicare would cover 80% of the approved amount: $4,000 (cost) x 80% (coverage) = $3,200
You’d be responsible for 20% coinsurance on the approved amount: $3,200 (approved amount) x 20% (coinsurance) = $640
Total Estimated Out-of-Pocket Cost: $240 (deductible) + $640 (coinsurance) = $880
Note: If your supplier accepts Medicare but doesn’t accept assignment for costs, they could charge even more for the device. So if the wheelchair costs $5000 and only $4000 is approved, you would be responsible for the excess costs.
That means you would also have to factor in an additional $1000 to your costs, bringing your total in the above example up to $1880.
The out-of-pocket expenses for a PMD can really add up!
Supplemental Programs
There are two main options to help with the out-of-pocket costs that Medicare alone doesn’t cover: MediShare 65+ and Medigap.
Let’s take a closer look at each of these options, and how they can help reduce costs for a PMD.
Medi-Share 65+
MediShare 65+ is not insurance, it is a health sharing program that is an affordable alternative to Medigap plans.
Members make monthly contributions that are used to share the medical expenses of other members.
Out-of-pocket costs for hospitalizations, durable medical equipment, office visits, and skilled nursing facility care are all eligible for sharing.
With a MediShare 65+ plan, you would still need to go through all the steps of getting your PMD through Medicare Part B.
Then you are responsible for an annual per-household contribution of $500. This amount functions similarly to an annual health insurance deductible.
After that, your eligible out-of-pocket expenses can be submitted to Medi-Share 65+ for sharing. If your device is medically necessary and approved by Medicare, Medi-Share 65+ will share 100% of the cost above your $500 annual household portion.
If you’ve already spent $500 on qualified medical expenses earlier in the year, Medi-Share 65+ will pay 100% of the cost.
MediShare 65+ provides other significant discounts and benefits to their members as well, which can potentially help you save money on all your healthcare needs.
Learn More: The Less Expensive Medicare Supplement Alternative: Medi-Share 65+
Medigap Plans
Medicare Supplement Insurance Plans (Medigap) are another way to help cover the expenses of deductibles, copays, and coinsurance.
There are a variety of Medigap plans to choose from. The right plan can help cover the out-of-pocket costs for an electric wheelchair or scooter.
Finding the best plan for your situation can be a challenge. You’ll want a plan that offers comprehensive coverage for Part B coinsurance and deductibles, as these will cover durable medical equipment (DME) costs.
Medigap Plan G is the most comprehensive plan available to new Medigap enrollees. It covers 100% of Medicare Part A and Part B-approved costs that Original Medicare doesn’t pay – with the exception of the Part B deductible.
Medigap plans do have monthly premiums you’ll need to pay, and these premiums can vary depending on your age, location, and the specific plan you choose.
Medigap Plan G Example
Here’s an example of how a Medigap Plan G policy would work to help cover the out-of-pocket expenses of an electric wheelchair you obtained through Medicare Part B:
- Wheelchair Cost – This could vary depending on the specific model and features, ranging from a few thousand dollars to upwards of $10,000 or more.
- Medicare Part B Deductible – For 2024, it’s set at $240.
- Medicare Part B Coinsurance – Medicare should cover 80% of the approved cost after the deductible. So, on a $4,000 wheelchair (assuming Medicare approves it), you would be responsible for 20% coinsurance on the remainder, which would be $3,760.
- Medigap Plans G – Your Part G plan would pick up 100% of the $800 co-insurance. You would only have to pay your Part B deductible of $240, as of 2024. Once your deductible for the year has been met, all other Medicare Part A and Part B services are fully covered. You will have no further out-of-pocket costs.
Had you elected not to carry any additional protection other than Medicare itself, you would have had to pay your deductible of $240, plus an additional $800 in coinsurance costs, for a total of $1,040 out of pocket.
Learn More: How Much Should I Spend on a Medicare Supplement Plan?
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.
- 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.
- 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.
- 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)
- 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)
- 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.
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
Scenario 2: Medicare Advantage Plan (Assuming Coverage)
Scenario 3: Medigap Plan A
Scenario 4: Medigap Plan G
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 |
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
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 Jablonski 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.