It is common for patients to come to my clinic with the request for power mobility devices, such as scooters or power chairs. If you watch TV very much during the day, you will see your share of companies marketing these devices. They make it sound like “Medicare will pay for it” and you can get one easily with just a signature from your doctor. This can put a physician in a very awkward situation.
It is true that Medicare pays for power mobility devices, yet only in very strict circumstances. The patient must need to use the device within their home to do basic activities of daily living, such as toileting or making meals. Many patients hope to get a scooter to make it easier for them to visit the neighbor’s house or use it around department stores. However, Medicare does not pay for people to use the scooter or power chair outside of the home unless they also have a strong need for it within the home.
Several details must be considered in a power mobility evaluation. The physician must certify that the patient needs to use the power mobility device in their home to do the basic activities of daily living, and that use of a manual wheelchair, walker or cane will not be enough to meet their needs. We must also certify that the patient’s home environment has door frames and inside space wide enough to accommodate the power chair or scooter. A physical therapist often has to go to the home to evaluate the inside space and confirm that the power mobility device will work inside the home.
In addition, Medicare does not pay for ramps to get the power mobility device in and out of the home, nor does it pay for car lifts or trailers to transport the device to another location. I have had patients over the years pretty disappointed because they had hoped to use their device to shop around the grocery store, yet had no way to get it there.
Sometimes power devices break, and patients are told by power mobility companies that their machine is old enough that “Medicare will pay for another one.” But now the guidelines are more strict than they used to be, and patients sometimes no longer qualify because they do not need the power mobility device to do basic activities of daily living inside their home. Again, the doctor is put in the awkward position of sharing unfavorable news. In these situations it is better to try to repair the old chair than go without it completely.
Patients who do not have a need for a power mobility device in the home, yet wish to have a power chair or scooter for use outside of the home, should seek used models and purchase these on their own. A quick internet search will provide used wheelchairs and scooters at one-third the price that is typically charged new to Medicare. I even found a new scooter available at Wal-Mart for $600. While this still may not be affordable for seniors on fixed incomes, I appeal to the family members of these patients who are looking for a good gift for birthdays or other holidays that might be put to good use. If you buy it yourself, you can do whatever you want with it, and have no hoops to jump through to get it covered.
Power mobility devices are important medical tools that can definitely help disabled patients do activities of daily living in their home. They also can be helpful for activities outside of the home. Yet if that is the only reason a patient wants one, they may be badly disappointed. Don’t trust all of the things you hear about this on TV. Talk to your doctor about your needs and Medicare requirements before you get your mind set on using a power mobility device.
Dr. Janet Hurley is medical director of population health at Christus Trinity Clinic and board chair for the Texas Academy of Family Physicians. She practices family medicine at the Christus Trinity Clinic Herrington-Ornelas HealthPark.