| Insurance, Medicare
and Medicaid Funding for Assistive Technology
The health care system is a major resource of
technological devices for people with disabilities. Private insurance,
Medicare and Medicaid cover medical equipment, depending on the
policy and patient's medical diagnosis. An often-used term is "durable
medical equipment", meaning items that are intended for long-term
use, such as a wheelchair.
However, these funding sources can provide
a range of devices that can be defined as assistive technology.
There is a great deal of flexibility as well as confusion in this
area; most insurance policies are silent about technological devices
and neither the Medicare nor Medicaid rules address assistive technology.
Also, the trend towards "managed care" and other medical
cost-cutting moves can cloud the picture.
Insurance companies still are largely unregulated when it comes
to assistive technology. Insurance plans and policies usually don't
even refer to funding assistive technology devices and services,
but they fund specific equipment such as wheelchairs or scooters,
other medical equipment, and even things like air-conditioners,
when they are medically necessary. For instance, a person with acute
asthma may require an air-conditioner at home. Private insurance
companies require documentation and/or prescriptions so be sure
to provide them.
Private insurance companies also challenge or
deny claims because the equipment costs more than what is termed
"standard and customary." When this happens, call around
to medical equipment dealers in your area that sell the same piece
of equipment and get three quotes. You will most likely find that
"standard and customary" costs considerably more than
what an insurance company says it should cost, granting the policy-holder
a higher reimbursement! It could mean the difference of $600 or
more reimbursement if you are persistent and do your homework. (A
woman who bought a used wheelchair for $1000.00 was told by her
insurance provider that used wheelchairs normally cost about $150.00
in her area. She called around and got quotes of up to $1400.00
and re-submitted her claim. She was reimbursed $850.00, a typical
Medicare is a federal health care funding program available to people
older than age 65 and those younger than 65 who have been entitled
to receive Social Security Disability Insurance benefits. The scope
of Medicare's coverage for assistive technology devices is very
Medicaid is a joint federal/state program that provides health care
services to people with low incomes. To be funded by Medicaid, assistive
devices must specifically address medical problems and be prescribed
by a physician, so he or she is the starting point for accessing
assistive technology through Medicaid.
The physician must provide a medical diagnosis,
define the technology as "medically necessary treatment"
and as the least costly of treatment alternatives. This can include
prosthetics, orthotics, and certain speech-language and rehabilitation
Complicating Medicaid is the fact that the states
differ widely in the range of Medicaid services they provide. The
law requires states to cover a set of "mandatory services,"
but also lists "optional services" which states may or
may not provide through Medicaid. States also define services differently
and put different cost or duration limits on services which sometimes
seem arbitrary (with no or little relation to diagnosis). Still,
many people have secured assistive technology through Medicaid,
most commonly, augmentative communication devices.
Persistence in dealing
with health care providers
Insurance companies, Medicare and Medicaid all have an automatic
Never accept an initial denial as the final word. Provide whatever
documentation that will support your appeal, such as a letter of
medical necessity from your physician.