Simulated experiences accessing standard manual wheelchairs through Medicare-listed suppliers.

342Background: Older adults frequently experience mobility impairment, often necessitating mobility aids like wheelchairs. However, administrative and financial hurdles can impede access. This study investigates Medicare beneficiaries' experiences when attempting to obtain a wheelchair from Medicare-listed suppliers, with a specific focus on challenges relevant to older adults, including those with cancer. Methods: We identified the first 30 "Standard Manual Wheelchair" suppliers within 10 miles of Chicago, IL (60607) and Minneapolis, MN (55414) from the Medicare directory on March 2, 2025. From March 3-14, 2025, one investigator (MC) posed as a "secret shopper, " inquiring about a standard manual wheelchair for a family member with traditional fee-for-service Medicare. We gathered information on delivery, rental options, and out-of-pocket costs with insurance vs. cash. The University of Minnesota IRB deemed this descriptive study not human research. Results: We reached 51 of 60 (85%) suppliers. The median time to speak with staff was 51 seconds. No suppliers asked for clarifying clinical or insurance details. Only 36 of 60 (60%) had manual wheelchairs readily available; of these, only 18 (50%) accepted Medicare. Twenty-seven of 36 (75%) required documentation beyond a prescription (e.g., clinician's note, certificate of medical necessity). Fifteen of 36 (42%) estimated delivery times of several weeks or couldn't provide a timeline. Of 18 Medicare-accepting suppliers, 15 (83%) provided cost data, with 14 (93%) correctly quoting 20% out-of-pocket. Among 36 cash-pay suppliers, 29 (81%) quoted prices; the median cash price was $250. The median cash rental price was $100/month. Five mentioned Medicare's rent-to-own program. Conclusions: This secret-shopper study revealed significant barriers to wheelchair access through Medicare-listed suppliers in urban areas. Less than a third accepted Medicare insurance. Administrative burdens, including variable documentation requirements and lengthy or uncertain delivery times, pose substantial challenges, particularly for older adults managing complex health conditions like cancer. The median $250 cash price for suppliers not accepting Medicare could exacerbate financial strain for beneficiaries. These findings highlight the need for improved directory accuracy and reduced administrative burden to enhance access to affordable wheelchairs for older adults.