Medicare and Mobility Coverage

Millions of Americans suffer from a medical condition that severely and permanently restricts their mobility. Mobility problems may require assistive devices. The most simple and inexpensive assistive device is a simple cane, but for many, this will be inadequate to their needs to maintain mobility independence. Advanced mobility aids, including such devices as wheelchairs and power scooters, may be covered by Medicare.

The Importance of MRADLs

"Mobility coverage" is the blanket term for everything that pertains to Mobility Assistive Equipment (MAE). Most Medicare claims pertaining to MAE focus on giving the patient low-cost and high-quality access to either a power chair or scooter.

Because these products can be very expensive, they might be out of reach of the average patient without the help of Medicare and mobility coverage. For this reason, providers of MAE have worked hard to persuade government officials to accept more MAE claims and provide them with less scrutiny.

Your eligibility for mobility coverage will be impacted by whether or not your mobility problem affects your ability to perform a certain list of daily activities. These are known as Mobility-Related Activities of Daily Living (MRADLs) and, as the name implies, they are not optional for a patient's lifestyle.

Rather, they are essential daily functions that will have to be performed by a caretaker or other outside assistant if the patient is not provided with mobility aids. The most common MRADLs are as follows:

  • Going to the toilet
  • Eating and drinking
  • Dressing and undressing
  • Bathing and grooming

Whether you are considered to have a "mobility deficit" depends to a very great extent on whether or not your condition limits your ability to perform MRADLs. Your level of mobility limitation is understood in terms of these criteria:

  • Are you completely unable to perform MRADLs without assistance?
  • Are you at risk of injury or death if performing MRADLs unassisted?
  • Are you unable to perform MRADLs within a "reasonable" time frame?

If the answer to any of these is "yes" then it is significantly possible that you will be able to gain mobility coverage from Medicare. However, the level of assistive technology that will be covered is based upon the level of limitation you experience now.

Types of Mobility Assistive Equipment

Generally speaking, it is easy for patients to understand whether or not their mobility impairs them as discussed above. The challenge to Medicare patients comes when trying to obtain the most effective mobility aid that will covered under their policies.

Medicare recognizes several levels of Mobility Assistive Equipment, and will generally seek to cover the costs of the lowest level of MAE that matches the patient's needs. Common MAE types include, in approximately their level of sophistication:

  • Canes
  • Walkers
  • Manual wheelchairs
  • Power wheelchairs
  • Power mobility devices
  • Power operated vehicles such as scooters

In theory, Medicare can cover all of the above options. However, an individual patient must meet certain criteria in order to receive coverage. In approximately the order given above, the "previous" MAE must not be sufficient to improve the mobility condition such that the patient can perform MAEs.

The selected MAE must make a significant difference in the patient's ability to perform MRADL and must be something that the patient will be able to make use of effectively in the home. Though they seem simple, these rules create a great deal of room for interpretation.

Why Items May Not Be Covered?

There are several reasons why items may not be covered under Medicare and mobility coverage. One of the most common is that a doctor may determine that a mobility problem does not merit a specific MAE.

Again, the key factor is how much the impairment factors into common daily activities that are generally deemed private. However, physicians are often eager to help patients receive the best treatment possible.

There is another caveat to be aware of. Some patients may not be able to receive mobility coverage because it is deemed not to be effective in their particular case. For example, a patient who would benefit from a power scooter in performing MRADLs, but who cannot operate the scooter effectively due to other conditions, will not receive coverage for the device. This is at the discretion of Medicare and physicians.

If a condition is permanent, it may be easier to receive coverage for more advanced MAE devices than if a condition is temporary. However, in the case of long-term coverage of mobility or other assistive devices, it may be required to seek regular attention by a physician who can certify that your condition is unlikely to improve over time.

Providers of mobility assistive devices have wide experience working within the bounds of Medicare. You can seek information from them and they will generally be very helpful for evaluating your mobility needs. By teaming up with your physician and mobility supplier, it is very possible to work within the complicated mobility rules.