How Much Will It Cost Me
If your DME provider accepts the Medicare assignment costs, youll be paying 20% of the Medicare-approved amount, and then the Part B deductible applies. Medicare.gov says, depending on the type of equipment, you may need to rent the equipment, you may need to buy the equipment, or you may be able to choose whether to rent or buy the equipment.
After youve visited your doctor, and he/she has written you a prescription for a scooter, you can obtain details from a DME provider, and they can share options with you. General prices for a decent scooter will range from $750-$2,000.
Electric Wheelchairs Covered By Medicare
Medicare Part B has a Durable Medical Equipment benefit that covers things like walkers, wheelchairs, CPAP machines, diabetic supplies, and more. However, Medicare has a specific process for determining coverage for each piece of durable medical equipment you need.
Generally, Medicare will cover the least expensive option that meets your medical needs. You will have to meet specific criteria for any upgraded versions of durable medical equipment.
Electric wheelchairs are an upgraded version of manual wheelchairs. While Medicare does cover electric/power wheelchairs, you have to clear a few hurdles before they pay.
How To Get Your Lift Chair Covered
For Medicare to cover your lift chair, your doctor or treating physician must prescribe it by filling out an order stating that the equipment is medically necessary. Your doctor typically fills out a Certificate of Medical Necessity, which has questions aimed at demonstrating your medical need for the equipment.
Your supplier follows up with your doctor to ensure the form is submitted to either Medicare or your Medicare Advantage provider. Your doctor must complete and submit a new, updated order should your condition or needs change in the future.
Medicare will only cover lift chairs obtained from a Medicare-accepted supplier. Suppliers must be approved by Medicare and have a Medicare supplier number.
Which Wheelchairs Does Medicare Cover
The type of wheelchair your Medicare plan will cover depends on your mobility level.
If you have difficulty getting around but have maintained some mobility, a manual wheelchair is for you. This is also the best option for people who only need a wheelchair temporarily.
People with very little to no mobility may qualify for a motorized or power wheelchair.
Here are the steps you’ll have to take to qualify:
- Attend an office visit with your primary caregiver
- Have your PCP verify that you can get into and out of a power wheelchair
- Have your PCP verify that you can hold yourself upright in a power wheelchair
If you meet the above criteria, your doctor will write you a prescription for a power wheelchair.
Jazzy Select 6 20 Power Wheelchair
The Jazzy Select 6 2.0 is a power wheelchair Medicare covers. It has a sporty design and superior performance. The patented Active-Trac® Suspension combines with the Mid-Wheel 6® drive to give a comfortable, stable, and smooth ride, whether you are inside or outside. The adjustable high back seat will fold flat for better convenience and offers maximum support and comfort. There are replaceable back and seat covers available in different sizes. The flip-up foot platform is height adjustable. The non-marking tires make this power wheelchair great for indoor use. The armor shroud helps protect the controller and chair from dust, dirt, and wear and tear.
For custom rehab solutions visit QuantumRehab.com
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Does Medicare Pay For Wheelchairs
Medicare Part B pays for wheelchairs when your doctor or other health care provider deems it a necessity for treating your medical condition at home. In this case, a nursing home or hospital providing Medicare-covered care wont qualify as your home, but a long-term care facility would.
You must have a face-to-face examination, which can be in person or via telehealth, and have a written prescription from your health care provider before Medicare will consider wheelchair coverage.
Theres no need to worry if youre enrolled in a Medicare Advantage plan, because the plan is required to pay for the same medically necessary services and equipment as Medicare Parts A and B do. However, you must first call your plans primary care provider to find out whether your plan will provide the wheelchair.
Scooters For Seniors: The Bottom Line
Medicare is making it more difficult for folks who want help with purchasing a scooter today. One of our community members Dennis has this to say about Medicare reimbursement for scooters Medicare rarely pays for senior scooters. We submit claims all the time and they always deny them. You will end up paying out of pocket for a senior scooter.
So the best thing you can do today if you feel youre eligible for Medicare assistance is to follow the new strict guidelines and work with a sanctioned DME provider in your local community.
If you have tips to share, or would like to comment on this issue give us a shout in the comments below.
Amie has been writing about senior care products and services for the last decade. She is particularly passionate about new technologies that help improve the quality of life for seniors and their families. Seeing her parents and grandparents age made Amie ask herself, Would this be good enough for my loved ones? In her spare time, Amie enjoys outdoor adventures and spontaneous road trips. Learn more about Amie here
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How To Appeal A Denial Of Coverage
Medicare Advantage Plans must pay for the same medically necessary equipment and services as Medicare Part A and B. If your Medicare plan wont pay for a wheelchair you believe you need, you may appeal the denial of coverage and get an independent review of your request.
The appeal process for wheelchairs and other DMEs is the same as for other Medicare-covered services. In Original Medicare, the appeal starts with the Medicare Administrative Contractora private health insurer with the geographic jurisdiction to process Original Medicare medical claims or Durable Medical Equipment claims. In Medicare Advantage, the appeal process starts with the plan administrator.
If youre denied coverage, you should receive a denial letter that provides information on deadlines to appeal and the process to follow.
Manual Wheelchairs And Scooters
If a doctor determines that a manual wheelchair or scooter is medically necessary, they may create an order, certificate, or prescription.
The order usually mentions the following:
The face-to-face meeting should occur no more than 6 months before the doctor writes the order.
Once the person has the order, they should take it to a Medicare-approved DME supplier.
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Will Medicare Pay For An Electric Wheelchair
With all of the TV commercials that advertise getting an electric wheelchair at little or no cost, its easy to believe all seniors have access to electric wheelchairs when they want one. When it comes time to buy an electric wheelchair, you may be surprised to find that Medicare may not cover the cost of an electric wheelchair like you may have hoped. Here is what you need to know about Medicare coverage for an electric wheelchair.
What Wheelchairs Does Medicare Cover
Medicare part B coverage provides the needed durable medical equipment .
This typically includes coverage for wheelchairs, scooters, and other mobility equipment that you need to get around.
Before you receive DME, it is crucial to check with your medical equipment supplier to see if they are enrolled in Medicare. Assignment means the medical supplier can cost you only coinsurance and Part B deductible health plans.
There are no limits on how much your contract supplier might charge you if they are not willing to participate in your assignments.
Lets look at what wheelchairs are covered by Medicare as well as its wheelchair medical insurance and coverage requirements.
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Which Medicare Plans May Be Best For You If You Know You Need A Wheelchair
If you think youre going to need a wheelchair in 2020 and youre eligible for Medicare, you will need to decide which plan will best meet your needs.
Medicare Part A covers hospitalization. If you need a wheelchair during a hospital stay or while you are in a nursing home, the facility will provide you with one.
Medicare Part B covers medical services. Under Part B, wheelchairs are covered as durable medical equipment.
Medicare Part C is also called Medicare Advantage. Since Medicare Advantage plans are required to cover the same benefits as original Medicare , wheelchairs are covered under these plans. The specific benefits and requirements will vary from plan to plan.
Medicare Part D is prescription drug coverage. Even though you need a prescription or a doctors order to obtain a wheelchair, they are not covered under this part of Medicare.
Medigap are add-on plans to help you pay for costs that Medicare does not cover. Some Medigap plans could help you pay for some or all of the expense of a wheelchair.
What Exactly Is A Lift Chair
A lift chair helps a person go from a sitting to standing position. The chair usually looks like a reclining chair, but it has the ability to rise or lift on an incline when you push a button.
Sometimes, lift chairs have additional features, such as heat or massage. Some chairs may even transform to a completely flat position, which would allow you to as well.
With many additional features or upgraded upholstery materials available, the costs of lift chairs are also highly variable. Most chairs range from several hundred dollars to a thousand dollars.
Its important to note that a lift chair is not the same as a stair lift, which is a seat that takes you from the bottom to the top of a staircase by pushing a button. Its also not a patient lift, which helps caregivers transition you from a wheelchair to a bed or vice versa.
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How To Get Medicare To Cover Your Wheelchair Or Scooter
To get started, youll want to schedule an appointment with your primary care doctor or another doctor that is currently treating you. During this face-to-face appointment, youll want to discuss all of your mobility challenges. Explain why you feel you need a wheelchair or scooter.
Being unable to do normal, day-to-day activities inside your home, such as:
- Getting out of bed
- Dressing yourself
- Getting to the bathroom
The above are all acceptable reasons for requesting DME. Its essential to clearly communicate with your doctor what limitations youre facing. This will ensure they prescribe you the correct type of device.
How Does The Prior Authorization Process For Dme Work
If your doctor prescribes a power wheelchair, your DME supplier sends Medicare the documents for you. However, you can forward the request and documents to Medicare yourself.
Once Medicare reaches a decision, your power wheelchair supplier receives a letter outlining the determination. Keep in mind, you can also contact your power wheelchair supplier and Medicare directly for the decision letter.
Your request may be denied for the following reasons:
- Medicare determines you dont medically need a power wheelchair
- Medicare doesnt get all the documents it needs to reach a decision
If Medicare needs more information, your supplier will resubmit your authorization request.
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Does Medicare Cover Wheelchairs
Wheelchairs are covered as durable medical equipment under Medicare Part B. If your doctor prescribes a wheelchair for you to use in your home, then Medicare will cover 80 percent of the cost. That leaves you to pay 20 percent after your deductible has been met. Your doctor and supplier must be enrolled in Medicare for the equipment to be covered.
Medicare may pay only for you to rent a wheelchair not buy one because a wheelchair is a more expensive and substantial purchase than other common equipment. Medicare typically requires beneficiaries to rent and not purchase items that are considered DME.
But any repairs or replacement parts that you may need will be covered by Medicare only if you own the equipment, while costs for rented items will fall to the supplier. Medicare often pays for equipment like wheelchairs to be rented for up to 13 months.
If you are prescribed a wheelchair to use in your home, you may want to look into various home modifications that can prevent falls and accidents. Past studies have shown that these modifications lead to fewer injuries among wheelchair users.
How Reimbursement Works
If you buy your lift chair from a Medicare supplier, youll likely pay for the total cost of the chair upfront and can then seek partial reimbursement from Medicare.
As long as the supplier participates in Medicare, it will usually file a claim on your behalf. If, for any reason, the supplier doesnt file the claim, you can online. To submit the claim, you will need the following items:
- the claim form
- a letter explaining the reason for submitting the claim
- supporting documents related to the claim, like your doctors prescription
The supplier or you must file the claim within 12 months of purchasing the lift chair.
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Medicare Part B Costs
Medicare Part B is the portion of Medicare that pays for the lifting mechanism of the lift chair. With Part B, youll first need to meet your deductible, which is $203 in 2021.
Once youve met the deductible, youll pay 20 percent of the Medicare-approved amount for the lift mechanism. You will also pay 100 percent of the remaining cost of the chair.
Does Medicare Cover Scooters
One of the most pertinent concerns for most seniors is the amount they will have to pay out of pocket for a scooter. If your DME provider is willing to work with your insurance and accept the assignment costs, youll have to pay 20% of the amount approved by Medicare. The Part B deductible will apply to the remaining amount.
Those who arent qualified for Part B can find decent scooters anywhere from $750 – $2,000. Youll find a massive selection of mobility scooters at Parentgiving.com that sit in this price range. Each order is backed by a top of the line customer support team that will aid you through the ordering process.
Depending on where you live, you may be subject to Medicares Competitive Bidding Program. Medicares durable equipment, prosthetics, orthotics, and supplies competitive bidding program can change the amount Medicare would typically pay for a scooter.
According to Medicare.gov, suppliers submit bids to provide certain medical equipment and supplies to people with Medicare living in or visiting, competitive bidding areas. Medicare uses these bids to set the amount it pays for each item. All suppliers are thoroughly screened to make sure they meet Medicare requirements before theyre awarded contracts.
Overall, as long as you qualify for Part B you will still only pay 20% out of pocket for a mobility scooter included in the Competitive Bidding Program.
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Await Submission Of A Standard Written Order
The practitioner who performs your examination should prepare a standard written order , which documents that the wheelchair is a medical necessity. This is sent to a Medicare-approved supplier before it can deliver the equipment.
Only the practitioner who performs the in-person examination can write the SWO, which they must submit within six months after the examination.
What Is A Lift Chair
A lift chair is a device that helps people get up and down from a standing or sitting position. They are motorized devices that are self-controlled to help you get from your seated position to a standing position.
They also help you get back down without having to crash down into the chair. While they dont double as beds, they can also be used as a quick napping option so you dont have to get up and go all the way to your bed in these situations.
Most lift chairs look like your everyday recliner, but they are used to help you get completely up from a sitting position rather than solely give you a nice seat to recline and relax in. Lift chairs are essentially pieces of medical equipment.
There are three main types of lift chairs:
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What Will My Out
Also, depending on where you live, your equipment may be subject to Medicares competitive bidding program. If you live in an area where this applies, you must get your scooter from a vendor contracted with Medicare under the competitive bidding program. This can help lower the costs.
Before picking a supplier, make sure that the supplier, as well as your doctor, are both currently participating in Medicare. Then discuss your payment options and whether you should purchase or rent the wheelchair from the supplier.
Make your decision based on the length of time you will need the device. Part B only pays for a portion of the total cost on your device. Meaning there will be 20% of that cost left for you to pay, out of pocket.