Mobility

• Mobility Scooters

  • Being unable to move about on your own is not only a limit on your independence; it can affect your health. There are medical problems that can result from a lack of mobility including deep venous thrombosis, osteoporosis, malnutrition, and poor hygiene. Your lack of mobility can prevent you from going out, and can even affect getting around in your own home. Fortunately, there are options to keep your independence—mobility scooters. They aren’t just about convenience, a scooter or motorized wheelchair can also improve your health. Mobility scooters (medical scooter, elderly scooter) may be covered by Medicare. Mobility scooter lifts, for stairs or vehicles, are not necessarily covered. The Center for Medicare and Medicaid Services (CMS) determined that these devices are “reasonable and necessary for beneficiaries who have a personal mobility deficit sufficient to impair their participation in mobility-related activities.” These mobility-related activities include basic daily functions such as washing, bathing, and cooking. Medicare often refers to mobility scooters as “mobility assistive equipment” or MAE. This term refers not only to mobility scooters, but to everything from canes to power wheelchairs and vehicles.
    
    How Do I Become Eligible for a Mobility Scooter?

    There are a few things. It starts, however, with your health care provider.
    Your doctor needs to submit a written order saying you have a medical need for a scooter (or wheelchair) in your home. You must have a personal checkup with your doctor—you cannot request a scooter over the phone. Also, you must primary need the scooter for use in your home—it cannot be mainly for recreational or outdoor use. However, this doesn’t imply that you can never use it outside the home.
    
    Qualifying Conditions

  • You must meet each of these qualifying conditions:
  • A health condition that makes it hard for you to move in your home.
  • Daily activities are impossible even with use of a cane, crutch, or walker. Activities include bathing, dressing, getting in and out of bed (or chairs) or using the restroom.
  • You need to be able to operate the scooter or wheelchair, or have a caregiver help you use the scooter/wheelchair safely.
  • The equipment must be usable in your home with open pathways.

  You qualify for a motorized wheelchair if you are unable to operate a manual chair. But to qualify for a mobility scooter, you must be physically able to sit upright and operate the controls. This sounds easy but some health conditions may make one or the other (or both) impossible. Your physician can help determine if you are capable of using a scooter safely.
  
  Medicare Coverage
  
  If Medicare approves, they will pay 80 percent of the Medicare-approved amount, while you pay 20 percent. You must also meet the Medicare Part B deductible. Anything covered under Medicare must fit into a benefit category and not be excluded by law. In some states, you may need to get your scooter or wheelchair from a specific, approved supplier. If you only need a scooter for a short time, it may be financially feasible to rent one. Be aware that some unscrupulous individuals and companies have taken advantage of Medicare policies regarding mobility scooters.
  
  A couple of things to keep in mind regarding potential fraud include:

  • A company that offers you a free wheelchair or scooter. Even if you qualify you will likely have to pay 20 percent.
  • A company that offers to waive your copayment.
  • If Medicare is billed for equipment you never received.
  • If Medicare is billed for equipment after it is returned.

  There are also different types of scooters to consider—some have three wheels and others include four. There are scooters that are designed for indoor use and others that are more versatile. Look for a scooter that will fit in your living space and that you can use easily.

• Electric Scooters

  • If you are having difficulty with mobility or feel that you aren’t able to get around safely, there are mobility products available to help you. A mobility aid will allow you to maintain your independence and improve your safety from falls and injuries. These aids range from canes and walkers for people who are fairly mobile, to electric scooters, manual wheelchairs, and power wheelchairs for those with significantly decreased mobility. If you fall into the last category, an evaluation is necessary to determine if a scooter, manual wheelchair, or electric wheelchair is best for your needs.
    
    Get an Evaluation
    
    The first step in getting a mobility aid is to be evaluated by your doctor. An occupational therapist may conduct your evaluation, but the doctor must first write a prescription if you are using your Medicare coverage. The doctor or therapist uses certain criteria to decide which mobility product is best for you.

    The following will be checked during your evaluation:

  • Your overall strength: If your upper body and legs are weak, you may not have the strength to use an electric scooter or manual wheelchair. To use a scooter, you have to be able to hold yourself upright without assistance or support.
  • Your upper-body strength: Even if you have sufficient body strength, you must have enough strength in your upper body, arms, and hands in order to operate a mobility scooter. Your upper-body strength will also determine if you are able to operate a manual wheelchair or if you need an electric wheelchair.
  • Your balance: If your balance is impaired and your posture is poor, you may not be able to remain upright to use a manual wheelchair or stay on a scooter.

  Choosing an Electric Scooter
  
  If your evaluation has established that an electric scooter is the mobility product that best fits your requirements, you can begin to decide what type of scooter you need. There are many styles of scooters with a wide variety of options and accessories. All models of scooters have the same basic features. They have a seat on top of a wheeled platform and a column at the front with controls or hand-rests. The column is called the tiller. The base unit will offer support for your feet and contains the drive system and battery. Your doctor or therapist will have specific results that will help determine your choice. For instance, if you have less hand strength, that will mean that you would have difficulty using hand controls. Other types of controls are available.
  
  The following are other factors to consider:

  • Where will you use your scooter? Electric scooters are available in three- or four-wheeled models. If you will be using your scooter primarily outdoors, the four-wheeled model will offer more stability and is easier on rough terrain. The three-wheeled model works well inside since it is easier to maneuver in smaller spaces.
  • Will you be taking your scooter with you in your vehicle? There are full-size electric scooters and portable scooters. The portable scooter can be folded and placed in a vehicle. This is good if you are still driving and don’t want to purchase an additional scooter lift that is necessary for a full-size scooter.

  Medicare Coverage for Electric Mobility Scooters
  
  Medicare Part B will cover most of the cost of electric mobility scooters, but only if your doctor determines that it is medically necessary. The scooter must also be used primarily for moving about your home and not as a “recreational” vehicle. You may have to pay up to 20% of the cost after meeting your Part B deductible.

  Other requirements for Medicare coverage include:

  • Your evaluation must be with a doctor or other qualified health provider
  • The evaluation must be documented and say that you need a mobility aid for a medical condition (called a “Certificate of Medical Necessity)
  • You must present the order or prescription to the Medicare-approved electric scooter supplier before Medicare can be billed
  • You must be able to safely operate, and get on and get off of the scooter
  • You must have good vision
  • You must have a health condition that causes difficulty for you to move around in your home

  Changes to Medicare Coverage for 2011
  
  There have been changes to Medicare coverage for “Durable Medical Equipment,” which includes things like medical supplies and electric mobility scooters. It’s important that you read and understand these changes. In an effort to cut costs, Medicare began to implement what is called “Competitive Bidding” at the end of 2010. This meant that Medicare-approved providers and suppliers of durable medical equipment were required to submit competitive bids for their products. There is a selection process in which the “winning” bids and those suppliers become Medicare-approved.

  Also, there are now much stricter guidelines for doctors and providers who evaluate your need for a mobility aid. These evaluations have always been face-to-face for Medicare to approve a wheelchair or scooter, but now these evaluations are even more lengthy and detailed.
  
  If you have questions about covered suppliers, go to www.medicare.gov/supplier where Medicare-approved suppliers are listed or call 1-800-MEDICARE (1-800-633-4227).

• Electric Wheelchair

  • People with mobility problems, especially older adults, have two main concerns about not being able to get around easily or safely—they will suffer a fall or they’ll lose their independence if they aren’t able to care for themselves. These are very real concerns. According to the Centers for Disease Control and Prevention, fall occurs in one out of three adults age 65 and older, and many of those result in serious injury. As you become less mobile, you often become more dependent on family or friends. If your decreased mobility is significant enough that you need help with daily living activities within your home, you may want to get a mobility product like a wheelchair or electric scooter. In order to find out what is best for you, you’ll need to have an assessment by your doctor. This is especially important if you get it through your Medicare coverage.
    
    Have an Assessment
    
    During your exam, he will evaluate the following:

  • Your ability to walk without any support: if you’ve reached the point where you are not able to walk by yourself without assistance, he will know that you need a mobility aid.
  • Your body strength: If you are not able to stand or hold yourself upright for any length of time, you will not be able to use a four-pronged walker or rolling walker.
  • Your posture and balance: Using a power mobility scooter or manual wheelchair requires some degree of balance and the ability to sit up straight without support.
  • Your upper-body strength: Like posture and balance, in order to use a manual wheelchair or scooter, you will need to have enough upper-body strength.
  • Hand and arm strength: A scooter or manual wheelchair requires that you have enough strength to squeeze hand controls, brakes, or wheel yourself in a chair.

  After your assessment is complete, your doctor will discuss your options with you. If he has determined that you need an electric (also called power) wheelchair, he will write his recommendation. This is like an order or prescription, and you will need this in to begin looking for your power chair.
  
  What Do You Need in an Electric Wheelchair?
  
  Now that you have your doctor’s recommendations, including specifics like what type of controls you need for your wheelchair, you can determine what kind of chair you need.

  • Do you plan to use your wheelchair outdoors or mainly indoors? Different models of power wheelchairs are made to be used mostly indoors, outside, or both. Most models are able to go either place, but some features are specific to outdoor use, especially if you will be on rough surfaces. Some chairs have a tighter wheel-radius so they are easier to maneuver in small, tight indoor spaces.
  • What are your functional limitations? If you need additional support from the seat or back of your electric wheelchair, there are features available. If you have very limited arm mobility, you may not be able to operate a joystick control. There are other control options—for example, a “sip and puff” control allows you to inhale and exhale into a tube to control the chair.

  Does Medicare Cover the Cost of My Electric Wheelchair?
  
  Most of the cost of your power wheelchair is covered under your Original Medicare Part B coverage. But you must meet all the criteria:

  • Your doctor must write an order for your electric wheelchair. A face-to-face examination is required and the order must inform Medicare why you need the mobility product.
  • Your wheelchair must be medically necessary.
  • You must be able to operate the wheelchair. Your doctor’s orders must say that you are physically capable of operating the chair.
  • You are unable to do the normal activities of daily living. This includes bathing, dressing, getting out of bed or going to the bathroom.
  • You’re able to safely operate the wheelchair. You can get on and off the wheelchair or have someone with you that can help.
  • You must be able to use the equipment in your home. You have clear pathways in your house so the wheelchair will not be blocked.

  Medicare Part B will pay up to 80% of the cost of the electric wheelchair from a Medicare-approved provider. You will have to meet your yearly deductible.

  Changes to Medicare Coverage for Durable Medical Equipment for 2011
  
  Medicare has started a “competitive bidding” program to lower the costs of providing services to its subscribers. As of January, 2011, all suppliers of durable medical equipment (like wheelchairs) must submit bids to become or remain Medicare-approved providers. Medicare then selects those that offer the lowest bids. NOTE: With these changes, it’s very important that you determine if a wheelchair supplier is Medicare-approved before you get your wheelchair.

• Manual Wheelchairs

  • Sometimes due to injury, recovery from surgery, a disability, or decreased mobility as you age, you may need to use a wheelchair. If it will be for temporary use, you may just rent a wheelchair. But for permanent use, you should familiarize yourself with different types and features of wheelchairs.
    
    Types of Wheelchairs
    
    There are basically two types of wheelchairs—manual and electric (or power) wheelchairs.

  • Manual: A manual wheelchair is designed for people who have enough upper-body, arm, and hand strength to self-propel the wheels of the chair. You must also have sufficient balance and posture to sit upright in the wheelchair because there is not as much back support in this type of chair.
  • Electric or power: Electric wheelchairs are for people who need support for their upper body and who are unable to move a manual chair with their arms and hands. A power chair has a more supportive seat and often a headrest for people who aren’t able to hold themselves upright.

  What Type of Chair is Best for Me?
  
  Your doctor will need to determine which type of wheelchair is right for you. His evaluation will look at your ability to move as mentioned above—balance and posture while sitting, upper-body strength, and use of your arms and hands.
  
  He will also check the following:

  • Transfer: Your ability for transfer safely in and out of the wheelchair.
  • Use of the controls: Your ability to stay safely in the chair and use the controls.
  • Your vision: Your vision must be adequate so that you can see to operate the controls, see ahead and around you while moving in the wheelchair.

  If your doctor has decided that you are able to operate a manual wheelchair, he will document that you have a “medical necessity” for the wheelchair. He will then write a prescription for your chair. Both the documentation and prescription (also called an order) are needed for Medicare to cover most of the cost of your wheelchair. Now that you have your prescription, you can begin to shop for your manual wheelchair.
  
  What Features Do I Want in My Manual Wheelchair?
  
  In the past, there was only one kind of manual wheelchair that everyone used. Now there are all types of models—folding wheelchairs, sports wheelchairs, travel wheelchairs, and even shower wheelchairs. You will most likely choose between a folding and a rigid-frame manual wheelchair.

  Some things to consider about your choice:

  • Folding frame wheelchairs: This type of chair is a standard wheelchair and very sturdy, but can still be folded sideways as needed. However, it is fairly bulky and heavy to transport, and you would likely need help to load it into your vehicle. Although this style is more convenient for travel, it isn’t as durable as the rigid frame model.
  • Rigid frame wheelchairs: This style is also foldable for transport. Although it has a rigid frame, they are usually made of lighter weight aluminum that you can easily load by yourself.

  Keep in mind that your doctor or occupational therapist has evaluated you for a chair with specific features. Factors they have considered are:

  • Your age, weight, height, gender and your ability level.
  • What Specific Features are Important?

  Here are some questions to answer when shopping, after following the doctor or therapist’s orders:

  • Is the chair mainly for indoor or outdoor use?
  • What form of transportation will I be using?
  • How many hours will I be spending per day in my wheelchair?
  • Will I have someone available to help me with my chair?
  • Will I have wheelchair ramps at my home or will I use a chair lift?

  The answers to these questions will help you know which features you will need for your manual wheelchair.

  Will Medicare Pay for My Manual Wheelchair?
  
  Manual wheelchairs are considered “Durable Medical Equipment” under Medicare guidelines. Most of the cost of your wheelchair will be covered under your Original Medicare Part B plan. You will have to pay 20% and meet your yearly Part B deductible.
  
  In order for your wheelchair to be covered, remember the requirements:

  • It must be medically necessary, as determined by a doctor
  • Your doctor has documented this information for Medicare
  • You have a “Certificate of Necessity” (like a prescription)
  • You must purchase your wheelchair from a Medicare-approved supplier

  Changes to Medicare Coverage for Durable Medical Equipment for 2011
  
  As of January, 2011, there are new guidelines for Durable Medical Equipment. Medicare is using a new program called “competitive bidding" to help save you and Medicare money, and ensure that you get quality equipment, supplies, and services. In some areas of the country, you must use specific suppliers or Medicare will not pay for the item. It’s important to see if you are affected by this new program. It is now effective in the following states: CA, FL, IN, KS, KY, MO, NC, OH, PA, SC, TX.

• Wheelchair Options & Accessories

  • Both manual and electric wheelchairs can be customized with a variety of options and accessories. These “extra” features make your chair individualized for your particular needs and also can add conveniences that wheelchair users appreciate.
    
    Options for Physical or Medical Needs
    
    Many times a person’s particular disability or health issue will necessitate custom-fitted additions or adaptions to their wheelchair. The doctor or occupational therapist that conducted your evaluation will make these kinds of recommendations. You will then know exactly how your wheelchair should be modified to best suit you. Safe use of your chair is also an important issue.

  • Fit and function: These options or accessories customize the fit and function of your chair. If you are very tall or obese, your wheelchair will need to be adjusted for that. For instance, if you are unable to use the armrests on your chair because of a poor fit for longer arms, you will need customized parts.
  • Medical necessity: If you are an amputee, you will need specially-adapted features on your wheelchair. You might need an option that offers additional support for a part of your body, because of a particular disability. If you spend almost all of your time in your wheelchair, your seat cushion is a very critical option.

  Options and Accessories for Convenience or Lifestyle Fit
  
  Because people in wheelchairs spend so much time using them, it’s important that they have accessories and options that will make “living” in the chair much more convenient. Carrying items, transporting your wheelchair in vehicles, safety add-ons, like mirrors and lights can all make your chair easier to handle and accommodate your lifestyle.
  
  Some of these accessories or options include:

  • Baskets, bags, for the front and back of your wheelchair
  • Fabric choices for your seat cushions
  • Cup holders and other brackets or holders
  • Lifts or racks to transport the chair on a vehicle
  • Additional battery chargers
  • Upgraded tires

  Your wheelchair supplier can show you options that can be used with your particular chair. You may want to go to a showroom to try them out before deciding which to purchase.
  
  Does Medicare Cover Wheelchair Options and Accessories?
  
  This is an area of your Medicare benefit that has recently been revised. It’s very important that you understand the options and accessories that are considered appropriate for Medicare reimbursement.
  
  In order for any wheelchair accessory or option to be covered by Medicare, it must be:

  • Medically necessary: There are very strict criteria for this category. An order or prescription from your doctor is required to be submitted to Medicare. There must be adequate documentation that provides the reasons why a particular wheelchair accessory is a medical necessity.
  • Medicare will not pay for equipment ordered without the proper documentation.

  Guidelines Revised February, 2011
  
  The following is the language regarding Medicare coverage of wheelchair accessories and options. These were revised on February 4, 2011:

  • Non-medically Necessity Coverage and Payment: “For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements.”

  Your doctor and/or occupational therapist will know how to request coverage of some items that they feel are medically necessary. You will need to work with them to determine the exact rules about these wheelchair options and accessories.
  
  Changes to Medicare Coverage for Durable Medical Equipment for 2011
  
  If the wheelchair accessories and options are covered by Medicare Part B, the following new guidelines apply: As of January, 2011, there are new guidelines for Durable Medical Equipment. Medicare is using a new program called “competitive bidding" to help save you and Medicare money and ensure that you get quality equipment, supplies, and services. In some areas of the country, you must use specific suppliers or Medicare will not pay for the item. It’s important to see if you are affected by this new program. It is now effective in the following states: CA, FL, IN, KS, KY, MO, NC, OH, PA, SC, TX.
  
  If the options or accessories you need are covered by Medicare, most of the cost will be covered by Original Medicare Part B. You will be responsible for 20% and will need to meet your Part B deductible.
  
  Wheelchair Options and Accessories NOT Covered by Medicare
  
  Most of the items listed under the category of convenience or lifestyle will not be covered by Medicare because they are not considered medically necessary. This would include things that are for use outside the home and/or to do outdoor activities.
  
  Examples of those options and accessories are:

  • Holders for cups, canes, or crutches
  • Bags or pouches in which to carry items while in your chair
  • Anything used to transport your wheelchair with a vehicle
  • Wheelchair ramps

  Advocacy
  
  Because of the strict payment guidelines for options and accessories for your wheelchair, you may have to ask your health care provider to advocate for your needs. If they can make a compelling case that an item that you require is medically necessary, you may be able to have that item covered. The “convenience” items will not be covered by Medicare as they are not considered to be of medical necessity.

  
  

• Mobility and Medicare Coverage

  • Mobility, the ability to get around easily, often decreases with age. The U.S. Department of Health and Human Services estimates that as much as 37 percent of people 65 and older have limitations on their activities due to less mobility. Movements like reaching, bending, going up and down stairs, and getting in and out of the bathtub become difficult. Even walking can become harder as some older people have problems with their gait and balance.
    
    Many of the physical changes that happen with aging are normal, but can affect mobility. Some of those changes include:

  • Arthritis in the joints
  • Less physical energy
  • Slower reflexes
  • Loss of bone tissue (osteoporosis, especially in women)

  Exercise and staying as active as possible will help an elderly person maintain more of their mobility and strength. But sometimes the lack of mobility becomes serious enough that it begins to affect all aspects of life. Those affected don’t socialize as much, give up enjoyable activities, and frequently become housebound.
  
  This lack of mobility is often combined with a fear of falling. Older people often fear that they’ll break a hip or have another falling injury that would result in having to move out of their home. This can lead to a loss of their independence or an increased dependence on others for help. It can begin to feel like they are losing control over daily life decisions.
  
  Mobility Aids
  
  Fortunately, mobility aids like canes, walkers, electric wheelchairs, and electric scooters can help those with decreased mobility safely stay in their homes and maintain their independence. The correct type of mobility aid is determined by several factors—overall strength and balance are the most important. If you have good body strength and balance, using a cane will probably be the right mobility aid. If you aren’t as steady on your feet, you may need the extra support of a walker or rollator (wheeled walker). But if a cane or walker isn’t suitable for your needs, your doctor may suggest a power wheelchair or power scooter.
  
  In order to get a mobility aid, you’ll need to be evaluated by your doctor first. Here are some of the specific things they will measure:

  • Your upper-body strength: You need upper-body strength to be able to balance yourself on a scooter, which has less support than a power wheelchair.
  • Posture: Related to balance, you also must be able to maintain an upright posture to stay on a scooter. An electric wheelchair offers much more reinforcement for your weak upper body and posture.
  • Arm, hand and leg strength: Scooters require that you are able to work hand controls and brakes. For instance, if you don’t have the arm and hand strength required, you may need a power chair with a joy-stick control.

  Mobility Aids and Your Medicare Coverage
  
  There are guidelines you must follow in order to have Medicare pay for most of your mobility aid.

  • You must have your evaluation with a doctor or other qualified health provider.
  • The evaluation must say that you need a mobility aid for a medical condition.
  • It must be documented and submitted to Medicare. This is called a “Certificate of Medical Necessity.”
  • Like a prescription, you will need this information in order to get your new mobility aid.
  • When you are shopping for your mobility aid, you will need to be sure that the wheelchair or scooter supplier is Medicare-approved or “assigned” by Medicare.”

  Accepting “assignment” simply means that the supplier has agreed to accept what Medicare will pay. Your mobility aid is covered under Part B of Original Medicare. You may have to pay up to 20 percent of the cost after meeting your deductible.
  
  NOTE: If you have a Medicare Advantage Plan or a Medi-Gap insurance plan to pay for additional, non-covered services, you will need to check your specific plan.
  
  How Do I Find a Medicare-assigned Supplier?
  
  To find a supplier that is Medicare-approved, look on the Medicare website, www.medicare.gov, under “Find Suppliers of Medical Equipment in Your Area” or call 1-800-MEDICARE (1-800-633-4227). The dealer must have a Medicare supplier number and must also meet strict standards.