Will Medicare help pay for a high-end power chair?

[xsfxsf]

I would like to get a new power chair that is suitable for outdoor use, probably whatever Permobil's top chair is, with all the power features.

As a para is it even worth bothering to try and get Medicare to pay for it? I am sure they would not pay for the chair I would want, but do they allow me to transfer funds from the chair I approve to the one I would want? I actually do require power tilt/recline/legs (not sure I can prove it). It is hard for me to argue I need a fast, powerful chair with good shocks, I just want one.

The last time I looked into this it seemed to be virtually impossible to accomplish and I just bought a used power chair. I am wondering if the situation has changed at all.

[Gearhead]

I don't think they can apply funds for a push chair to a power chair to lower it's price.
Many dedicated outdoor chairs available but it's >extremely< rare that Medicare will cover one.
A front drive works fine outside although one with full chair functions weighs about 400 lbs + your weight. Something to think about depending on your outdoor environment.
If your doctor will write an RX for one, should be a done deal depending on DME competence. Don't forget about the 20% you'll owe if you don't have supplemental ins.

The Permobil F3 has 4 wheel adjustable suspension. Checking the mail today reminded me I need to soften mine.
My softest ride is a Permobil C300. Softened the rear shocks so much that it rocks back on full accel. Also the tires are so worn and soft, everyone thinks I have 2 flats. Never seen any tires that soft.

[SCI-Nurse]

Medicare regulations limit power chairs to only those who have a justification for needing a power chair indoors. Community mobility is NOT considered part of Medicare coverage. In order to get a power chair under Medicare, you must have an evaluation by a RESNA certified therapist or tech (PT or OT preferred). This person then writes a medical justification letter for each feature of the power chair, addressing it's need for you to be functional and medically safe inside your home (again, not in the community). This includes medical justification for such things as tilt and recline for weight shifts, leg rest elevation for edema management, etc. You provider must the sign the letter of medical justification, and this gets submitted to Medicare by your vendor.

Several years ago, my mother obtained a new power chair. It was a Permobil C300 with power tilt-in-space and power recline seating, power elevating leg rests, and a seat elevator, plus a Ride cushion. Each feature was justified in her medical justification letter, but Medicare denied the seat elevator as not medically necessary. The whole chair cost $32,000. Medicare covered $13,000, my mother's BCBS covered $5,000, and my parents were out of pocket for the remainder. I'm sure others here can tell you similar stories.

(KLD)

[landrover]

What is the justification/logic for Medicare's 'in-home use' only?

[SCI-Nurse]

What is the justification/logic for Medicare's 'in-home use' only?

It's in their regs, and disability groups have been fighting it for years. Since Medicare limits coverage of DME to what is "medically necessary", they consider in-home mobility to be a medical necessity, but don't consider community mobility to be so. They consider that "recreational use", so justify their denial of sports chairs for the same reason. Ironically, they also deny equipment for use in the bathroom (shower chairs, grab bars, etc.) also not to be "medically necessary).

Sucks, but that's what we have to deal with until we get decent universal health care legislation passed.

(KLD)

[Gearhead]

BEWARE, most DME's think of mid drive when thinking of an indoor chair. Mid drive sucks outdoors, in ever aspect. Been there, done that.
Rear drive is good outdoors but are horrible indoors. Front drive works good in and outdoors.
They will try hard to promote/push a mid drive on you. If you get a mid drive, you will regret it. Caster flutter, jerky casters, get stuck easy outdoors, rough ride, and more.