Wheelchairs and medicare

asoloFebruary 11, 2011

Getting to the point where I need wheelchair and potty-chair for mom (98 1/2).

Have been using loaners from local charity but they have time limits. Has become apparent we will need to own these items for the duration if she is to stay at home.

Don't know if medicare has provision for payment or partial payment for such items. We have medicare part A,B, and D. We have money, but things are certainly tighter than they used to be.

Have good local sources for purchase but they seem to know next to nothing about how medicare does or doesn't fit in.

Would welcome advice about how to proceed.

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Asolo, when I bought a walker for my mother, I found prices at local stores to be about twice as much online stores. The supplier in Southern CA that we used even had free shipping. And try Costco online, as well. Their prices on the walkers are good, don't know if they have wheel chairs.

We got a free, Medicare-issue walker, but it's only the bare bones aluminum zimmer. The models with larger wheels, baskets/seats were not available. And for those looking at buying walkers, the bare bones models with two small wheels are not safe outdoors and anywhere the surfaces are uneven; they tend to be less stable in those circumstances.

So, you might get a free wheelchair from Medicare, but don't expect anything but the barest models.

    Bookmark   February 11, 2011 at 2:03PM
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From Medicare.com. (would have linked rather than copied and pasted, but my links generally go somewhere in cyberspace)

"Medicare will cover manual wheelchairs. However, you must be able to show that it is deemed medically necessary by your physician and the primary use of the manual wheelchair must be for moving around your home. In other words, it just can't be something that would be convenient to have or primarily for use outside the home. However, you must follow the steps below to ensure that Medicare pays for the equipment:

You cannot walk, even with the support of other mobility equipment (canes, walkers, etc.).
You would spend most of your time in bed or in a chair without the use of a wheelchair.
You can transfer safely in and out of the wheelchair.
You are able to sit and ride safely in the wheelchair and can operate the controls.
The primary reason for needing the item is to help you move about independently, not to prevent an injury from occurring where no injury or illness exists (even though it will help prevent injury, as well).
The primary use will be inside the home. Although you can also use the wheelchair while outside the home, it may not be for use only when outside the home setting.

Only your doctor can prescribe the equipment for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you.
The doctor must document the need in your medical records and give you a signed and dated order (prescription) for the equipment.

How Do I Qualify For a Wheelchair?
You must have Medicare Part B coverage and you must have been assessed by your doctor. The doctor must have documented your need in your medical records, and must have written an order (prescription) for the equipment. The supplier must have the order on file before billing Medicare for the chair. In addition, the need for the wheelchair must meet the criteria in italics above.

Wheelchairs require a Certificate of Medical Necessity. Your doctor and Medicare supplier will know when that documentation is required.

How much does it cost for Manual Wheelchairs?
After you have paid your annual deductible, you will pay 20% of Medicare-approved amounts for the wheelchair rental. Those costs may be higher if the supplier doesn't accept assignment. Any cost for repairs or replacement parts for the equipment are the supplier?s responsibility.

Where Do I Rent Wheelchairs?
You will save money if you order your items from a Medicare- approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number.

You can find a supplier that is enrolled in the Medicare program by visiting www.Medicare.gov and selecting "Find Suppliers of Medical Equipment in Your Area." You can also call 1-800-MEDICARE (1-800-633-4227) 24 hours, 7 days a week, including some federal holidays. If the supplier from which you order your chair is not enrolled in Medicare, Medicare will not pay for the equipment.
Things you should think about before you choose a supplier:

There are two types of Medicare suppliers: participating suppliers, and those who are enrolled but have chosen not to participate.
Participating suppliers must accept assignment, which means they agree not to charge more than the Medicare allowed amount.
A Medicare-approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15% above the Medicare-approved amount.
If you receive your Medicare coverage through a Medicare Advantage Plan (like an HMO or PPO), it is likely that the plan will have its own steps for getting the equipment. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers -- they cannot supply less. Depending on your plan, you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan's customer service and ask if your chair is covered and how much you would have to pay before you order it."

    Bookmark   February 12, 2011 at 1:31PM
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Many larger cities have medical supply stores and even some medical centers have departments handling those supplies, not just for seniors. Do you have a senior center? council on aging? senior apts? etc. Watch for ads or contact those I listed and ask for help, both on getting what you want and buying/renting.

    Bookmark   February 12, 2011 at 4:41PM
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Thanks for these responses..especially duluthinbloomz4. I'm getting smarter day-by-day......I hope!

Sad and troublesome time here.

    Bookmark   February 12, 2011 at 6:52PM
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Don't forget to check craigslist, too. Sometimes after a family member dies, people post to get rid of eldercare items that are no longer needed.

Good luck to you, I know it's a tough time and tough environment to be facing these things.

    Bookmark   February 13, 2011 at 11:15AM
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My 82 year old Mother is recovering from a broken neck. We are looking for any available programs to assist with home modifications and medical equipment to allow a successfull transition from rehabilitation to home.
Thank you, Jonna

    Bookmark   March 15, 2011 at 4:47PM
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Jonna, you have a great resource at the rehab nursing home, the social worker. Start a dialogue there, and you should get pointed in the right direction. The social worker and the head of rehab and the nursing director won't let a patient go home until there is a proper environment, and they will help you.

As for home modification, like ramps, I'm pretty sure that Medicare won't cover that. If you are low income, you can contact a group like Christmas in April, which is also called Rebuilding Together.

Here is a link that might be useful: Christmas in April/Rebuilding Together

    Bookmark   March 15, 2011 at 7:51PM
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I was told in a medical supply facility that if you can not get around your home by yourself, you qualify for a scooter, so why can't you get a wheel chair????? I think you need to call medicare and talk to them.

    Bookmark   April 4, 2011 at 9:01PM
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My dad had a stroke & needed a wheelchair. We borrowed 1 for a short time from friends.Didn't work out well! Dr. gave us prescription for it since he could not walk without walker & safety belt & someone holding belt & 1 side of walker. They are very unstable if you want to fall off to 1 side,could easily flip it over. So wheelchair was best way to get dad to table & to his easy chair ,bathroom & bed. Not so easy. The wheelchair people came & measured couple of doors & brought a wheelchair, well, couldn't get it through area where bathroom is, too wide of wheelbase. Also when I tried to fold it & lift it so we could get him to dr. when required,they had sent out a heavy 1. So we measured doors & came up with narrower size,dad was only about 140 lbs so could have smaller area in seat without a problem. They got us a Karma Aircraft-Grade Aluminum Alloy frame chair with silver & black & very attractive & I could actually pick it up & get it in trunk of car(very important),easy to get through the house & he could even move it himself down the hall or out of kitchen so "not stuck somewhere", so lot of things to consider.We haven't had any problems with it, just added a thick cushion as he sat in it a lot with a soft light blue baby blanket(type that doesn't bunch up) so if he spilled food or drink could easily change it for another little blanket.(folded twice so about size of seat.) So anyone needing a chair these are the things you need to be aware of. My neighbor had a wheelchair & said I could use it- It wouldn't fit in the trunk of car even with 2 of us trying to get it in there. That's when I knew it was not going to be easy! Good Luck folks & be persistent!

    Bookmark   August 22, 2012 at 5:32PM
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Check with your state home builders association, there are programs for "governors houses" these are for low income families and are prefab houses build by prisoners in state penitentiaries.Then delivered to your site. But guess what??? they also build wheelchair ramps for people with need, there is programs available for accessibility, check on line for "free wheelchair ramps" there will be a world of information.

    Bookmark   November 27, 2012 at 1:36AM
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