Every insurance company may be a little different, and different types of wheelchairs will have different requirements, but as a general rule this is the basic, main criteria for most insurance:
🌷 You need the wheelchair inside your home – at least some of the time (Note: Once you get the wheelchair, you are allowed to use it outside your home as well. If you are not sure, please read this before making a final decision: Do I Need a Wheelchair Inside My Home? (Pop Quiz!))
🌷 You need the wheelchair to help with one or more Activities of Daily Living – such as feeding, dressing, toileting, or bathing. Inside your home. (Note: If you don’t need this every single time, but just some of the time or most of the time, you might still qualify.)
🌷 You cannot complete all your Activities of Daily Living using a walker or cane. (Note: Some people try getting one of these other pieces of equipment first, however, this is not required).
🌷 You do not have enough upper body functioning to use a manual wheelchair to do these activities (Note: This could be for a variety of reasons. For example, strength, endurance, range of motion, coordination, presence of pain, or missing limbs)
🌷 Your home has enough space for a wheelchair or scooter to move inside your home between rooms. (Note: If bedroom is upstairs, but you frequently using the living room as your sleeping space, this might qualify. Some insurance companies ask the medical supply company to check your home when they deliver your equipment.)
🌷 You can safely operate and get in and out of the wheelchair or scooter, or you have someone who can assist you to do this. (Note: When they deliver the wheelchair, they should show you how to use it)
🍃 Aetna Criteria for Electric Wheelchair
🍃 Aetna Criteria for Electric Scooter
🍃 Medicare Criteria for Scooters and Wheelchairs
LEARN THE LINGO
When looking at insurance policies:
🍃 Scooters are usually called “Power Operated Vehicles”
🍃 Medical equipment is usually called “Durable Medical Equipment” or DME
🍃 Self-care activities are called “Activities of Daily Living” or “Mobility-Related Activities of Daily Living” or “ADLs” or “MADLs.” This usually includes bathing, grooming, dressing, feeding, and toileting.
🍃 Activities that are not directly on your body usually do not count as ADLs or MADLs. For example, cooking and cleaning are not ADLs. These may be called “Instrumental activities of daily living” or IADLs.
Tools for Troublemakers
How to Get an Electric Wheelchair or Scooter Through Insurance
How To Save Spoons: A Self-Advocacy Guide for ME/CFS
Everything No One Ever Tells You About Living on Social Security Disability
Thanks for Reading
🌸 Art on this page by Robin Mead and Elizabeth D’Angelo.
🌸 Page Updated: 10/1/19
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