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WHAT HOME MEDICAL EQUIPMENT IS GENERALLY COVERED BY INSURANCE?

Updated: Apr 27

While most insurance follows the Medicare coverage guidelines (indoor use medical necessity), that is not a hard and fast rule. There is one important exception to the norm that may pay for additional mobility equipment:

Workers Compensation covers many types of equipment that help provide safe mobility and accessibility both indoors and outdoors. This may include items such as Mobility Scooters, long Modular Ramps, Stair Lifts, and Vertical Platform Lifts.


HERE ARE THE 3 MOST COMMONLY INSURANCE COVERED ITEMS

1. Powerchairs (ie power wheelchairs). These are also known as “power mobility vehicles” – and are primarily insurance covered when a person’s functional limitations (whether from an internal medical condition or a structural condition) equate to being:

a. Unable to safely self-propel a manual wheelchair “all day everyday” to meet activities of daily life.

Powerchairs provide safe mobility (greatly assists with preventing falls which are increasingly hazardous for older people), and are authorized when they are needed for indoors use.

A Note on Power Mobility Devices:

Mobility Scooters are generally not indoor use vehicles (primarily outdoors use) and are therefore in most cases self-pay items.


To get authorization:

Following a doctors’ mobility examination they will submit chart notes and place the order with the Medical Equipment Supplier. Once all the paperwork is received (and supports the order), an authorization request is submitted to Medicare or other insurance for approval. There is generally an average 30-40 day wait time for delivery.


1. Wheelchairs. Most insurances will cover a lightweight wheelchair (standard weight chairs are heavy - 40 lbs or more: A bit heavy for many users) when ordered by your physician. Wheelchair coverage:

a. Unable to safely ambulate with the use of a walker alone. Ordered to safely meet activities of daily life.

b. There is no approval wait time once doctor’s orders are received (which justify the order).

c. Accessories such as elevating leg rests, seat cushions, and back rest cushions are often included and covered.

2. Hospital Bed / Patient Room items. Most insurances will pay for a hospital bed and accessory items when ordered by your physician. Commonly covered items include:

a. Lightweight semi-electric hospital bed with half rails

b. Trapeze Bar

c. Overlay or pressure reducing mattress

d. Patient Lift

e. Bedside Commode


OTHER FREQUENTLY INSURANCE COVERED ITEMS INCLUDE:

Walkers, TENS units, Braces

Call Mobility Plus of CA. Monday-Friday: (209) 552-2244 and let one of our authorization specialists answer your insurance questions!


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