Medicare’s “medical necessity” requirement

Tucker – Wash.: Why does Medicare only consider reimbursement for a wheelchair used in the home? Do they want us to be shut-ins?

Phil Moeller: You’re correct that Medicare’s standard for wheelchair use is your doctor’s assessment that you have a medical need for a wheelchair inside your home. But you are then free to use it wherever you wish. I don’t see this as meaning that Medicare wants you to be a shut-in. However, if you can putter around your home without needing a chair, but you can’t walk very far outside the home, I can see where you’d feel this standard is unfair. In practice, basing Medicare coverage on your mobility outside the home would create a very slippery slope. How far would you need to walk unaided before you didn’t need a wheelchair? A mile? Less? More? How would this distance be tested? The medical need requirement is consistent with other Medicare coverage determinations. And the in-home standard, while certainly murky in some circumstances, is easier to consistently interpret.