A Written Order From Your Doctor
Your doctor must prescribe a motorized wheelchair for you. He/she must explain in a written form that a worker or cane will not provide the mobility you need and you need the wheelchair for mobility reasons. Medicare only covers an electric wheelchair when they are a necessary recommendation by your doctor. If your doctor is prescribing a motorized wheelchair, you must be unable to use a manual one. The doctor must specify the reason for needing a motorized wheelchair For example, difficulty getting in and out of bed, dressing up, using the toilet etc. The doctor must also write down if you will be using the motorized wheelchair or you will have assistants from a family member or a caretaker.
You Might Pay 20%and You Must Meet Certain Conditions
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This article is reprinted by permission from NerdWallet.
Medicare Part B covers wheelchairs and scooters if you need one to get around your home due to a medical condition. To ensure coverage, your doctor and the mobility equipment supplier must submit orders and documentation that meet various Medicare requirements.
To get a wheelchair, you must satisfy several conditions
Your wheelchair or scooter will be covered only if your doctor and your equipment supplier are enrolled in Medicare.
Medicare will pay most of the cost of your wheelchair or scooter if all of these conditions are met:
- Your doctor submits an order stating your medical need for a wheelchair or scooter.
- You have a health condition that makes it difficult for you to move around your home.
- You cant do activities of daily living such as getting out of bed and bathing with a cane or walker.
- Youre able to safely use a wheelchair or scooter on your own, or you always have someone available to assist.
- The layout of your home will accommodate a wheelchair.
Manual vs. power wheelchair or scooter
If you have sufficient upper body strength or a helper, you could qualify for a manual wheelchair.
Where Can You Get A Wheelchair
- If you have traditional Medicare, the wheelchair must be purchased from a Medicare contract supplier.
- To find out where to go for your wheelchair, Medicare at 1-800-633-4227 or go to the Medicare.gov website.
- If you are enrolled in a Medicare HMO or another private Medicare program, contact the plan and follow the guidelines of the program.
Remember that Medicare will not cover a wheelchair if you do not require one for usage in your house, even if you require it to get around outdoors.
However, if you require it for usage in your home, you may use it outside of your home as well.
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The Difference Between Medicare & Medicaid
Medicaid is a state-run program that provides hospital and medical coverage for low-income individuals. Each state has its own rules about who is eligible and what is covered under Medicaid. Alternatively, Medicare is a federal program available to all U.S. citizens after their 65th birthday. Some people qualify for both Medicare and Medicaid. For more information about the Medicaid program, contact your local medical assistance agency, social services or welfare office.
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Your Costs In Original Medicare
If you qualify for a wheelchair or power scooter, you must pay 20% of the permitted charges plus any relevant deductible.
A motor-powered scooter costs between $700 to $2,000 on average, therefore the total cost of the scooter may vary.
In addition, depending on where you live, Medicares competitive bidding program may apply to your equipment.
If you live in an area where this is the case, you must purchase your scooter from a vendor contracted with Medicare through the competitive bidding program.
As a result, the cost may be reduced.
Before selecting a supplier, ensure that both the provider and your doctor are currently enrolled in Medicare.
Then, talk about your payment options and whether you want to buy or rent the wheelchair from the supplier.
Make your choice based on how long you will require the device.
Part B covers only a percentage of the overall cost of your gadget.
That is, you will be responsible for paying 20% of the cost out of pocket.
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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Medicare Coverage Of Walkers And Canes
Medicare Part B covers canes as DME. This coverage does not include white canes for the blind. Your mobility must be significantly limited and affect you at home for Medicare to help pay for a cane.
Walkers and rollators are also covered, but only if they are deemed medically necessary. Your health care provider must prescribe the walker or rollator for use in your home for Medicare to cover it.
Unlike with wheelchairs, Medicare will likely help pay for you to buy canes and walkers instead of rent them. Medicare will cover 80 percent of the cost, and you will be responsible for the remaining 20 percent once you have paid your deductible. These items are covered only if your doctor and supplier are both enrolled in Medicare.
Does Medicare Cover A Broda Wheelchair
So, does Medicare, Medicaid, or other public government insurancecover the cost ofmanualwheelchairs? This is one of the most common questions wereceive. The short answer is:Yes!While payment can be made with cash or credit, you can also use funds from an insurance program.
Public, governmental, or other privately managed care insurance programs include:
You can also use supplemental insurance plans such as Medicare Supplemental Insurance.
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How To Get A Wheelchair On Medicare In 2022
You may have discovered that getting the wheelchair you need is a lot more complicated than you initially thought. You want to be able to roll around and enjoy your life. For many, Medicare coverage for a wheelchair is the best way to get one at a reasonable price without breaking the bank.
But its not as easy as you think, and there are several steps you need to take to make sure you get approved for Medicaid coverage for wheelchairs in your state. In this article, well walk you through all the steps you need to take to get a wheelchair on Medicare.
What Costs You Need To Cover
If Medicare approves coverage of your wheelchair, you still have a financial obligation to meet. Customary with any health insurance, you must meet your Part B deductible for that year, then cover 20% of the Medicare-approved amount. Usually, this approved amount wont exceed the actual charge or fee Medicare sets for the item.
Medicare will generally pay for the most basic level of equipment needed. If you need upgrades or extra features and your supplier thinks Medicare wont cover them, youll need to sign an Advance Beneficiary Notice before receiving the item. On this waiver form, you must check the box stating you wish the upgrades and will agree to cover their full cost if Medicare denies coverage.
You may have to cover the full cost of your wheelchair if you get it from a supplier that isnt a contract supplier.
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How Can I Get More Help Paying For A Wheelchair
You might be concerned about the 20% coinsurance you generally have for a wheelchair under Medicare Part B. If you have power wheelchair that is worth $4,000 or more you might be responsible for nearly $1,000 in coinsurance. Thats where Medicare Supplement insurance plans from private insurance companies come in. Medicare Supplement insurance plans cover various copayments, coinsurance, and deductibles not covered by Original Medicare. You typically have options for Medicare Supplement coverage, and all plans cover at least 50% of the Medicare Part B coinsurance. So if you were responsible for $1,000, you may only be responsible for $500 with Medicare Supplement coverage. Some Medicare Supplement insurance plans cover 100% of the Medicare Part B coinsurance cost. You may pay an additional premium to have a Medicare Supplement insurance plan.
To find a Medicare Advantage plan that also covers wheelchairs or a Medicare Supplement plan that helps you cover the out-of-pocket costs for a wheelchair, enter your ZIP code on this page.
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Medicares Competitive Bidding Program
Under the competitive bidding program, a number of different types of durable medical equipment are purchased through open bidding.
Additional assistance such as hospital beds and commodes are also covered in the program.
You will need to purchase a wheelchair from an approved provider if you live in an area covered by the competitive bidding program.
This is important, as they could stop covering costs related to your wheelchair or motorized scooter if you decline strict standards and costs for coverage associated with your treatment.
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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 Medicare Coverage Work With A Wheelchair
Wheelchairs are considered durable medical equipment under Medicare guidelines. Other examples of DME for mobility include walkers, canes, power scooters, and power wheelchairs. In order to qualify for Part B Medicare coverage of your wheelchair or other mobility device, you must meet the following conditions:
- Your doctor must write an order indicating that you have a medical need for a wheelchair to get around in your home .
- You have a health condition that limits your mobility and makes it difficult for you to move around your home.
- You need a wheelchair to help you with daily activities of living such as going to the bathroom, bathing, dressing, getting in and out of bed.
- You are physically able to safely operate a wheelchair or you have someone in the home that is always available to help you use it safely.
- Both the doctor who orders the wheelchair and the supplier who provides it must participate in the Medicare program.
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Where To Get Your Wheelchair
You can get a motorized wheelchair if you have traditional Medicare from a Medicare contract supplier. To find out where to go for a wheelchair call Medicare at 1-800-633-4227. Or you can visit their official website at gov.
If you are enrolled in a private Medicare plan or Medicare HMO, you should call the plan and follow their rules.
It is important to note that if you do not need a motorized wheelchair for use in your home, even if you need it to go outside, Medicare will not cover it. On the other hand, if you need to use it inside your home, you are permitted to use it outdoors as well.
John Erick
How To Get An Electric Wheelchair Through Medicare
Once you get the written order from your doctor, you can work with a DME provider to get an electric wheelchair. In some parts of the country, you will need to work through a Competitive Bidding Program to secure your electric wheelchair from suppliers that submit bids for the lowest price. Even if your area is listed, you may only have to use the Competitive Bidding Program if you live in certain zip codes or with some insurance plans. If you have any questions about which DME providers you can use or if you need to use a Competitive Bidding Program, it is best to contact your insurance provider directly with any questions.
It is important to give your written order or Certificate of Necessity to your DME provider as soon as possible, as youll need to make your electric wheelchair purchase within 45 days of receiving the order. The DME supplier may want you to meet with a representative to discuss your needs and preferences to ensure that you have the right model. You might be given the option to rent an electric wheelchair before buying it.
Even if Medicare will not cover an electric wheelchair because you do not meet the requirements for coverage, it does not mean that you cant have access to one. You can buy an electric scooter through third party vendors. Plus, there are some local government programs and nonprofit organizations that help low-income seniors have access to the mobility equipment they need.
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Need More Information About Medicare Coverage For Your Wheelchair
If youd like to know more about Medicare and wheelchairs, I am happy to give you more information and answer your questions. If you prefer, you can schedule a phone call or request an email by clicking on the buttons below. You can also find out about plan options in your area by clicking the Compare Plans button.
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How Does Competitive Bidding Affect Medicare’s Coverage For Durable Medical Equipment
You may live in an area that was using Medicares Competitive Bidding Program for durable medical equipment prior to 2019, or for some services in 2021. Beneficiaries in those areas needed to make sure they were using a Medicare contract supplier, but because the Competitive Bidding Program resulted in lower costs on durable medical equipment, the portion that the patient paid was also lower.
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How To Get A Motorized Wheelchair Through Medicare
If you or a loved one meets the coverage conditions, Medicare will pay for a motorized wheelchair. If your doctor prescribes it and you are approved, then Medicare will pay 80% of the cost of the electric wheelchair. The remaining 20% you are expected to pay. Wheelchairs are pretty expensive and can cost anywhere between $500 to $6000. It is easy to assume that all seniors/disabled people have access to motorized wheelchairs when they need one. But it is a surprising fact that Medicare may not cover the cost of this device like u may have assumed. Read below to know under what conditions Medicare will provide coverage for a motorized/electric wheelchair.
Does Medicare Pay For Wheelchair Ramps
Wheelchair ramps are essential, assistive equipment for people who use wheelchairs. Without one, moving a wheelchair up or down stairs is not only an arduous task but can also be a dangerous one. In light of this, getting a ramp set up for your home is a crucial need for many wheelchair users and unfortunately, often, a costly one, with many ramps costing hundreds, if not thousands, of dollars.
It is this cost that begs the question: Will Medicare pay for a wheelchair ramp?
Generally, Medicare will not pay for a wheelchair ramp. This is because Medicare Part B only subsidizes the cost of Durable Medical Equipment such as wheelchair ramps when they are deemed directly medically necessary by a licensed physician. That said, there may be exceptions under specific Medicare Advantage plans.
Despite this, fortunately, there are other ways in which you can acquire a wheelchair ramp without putting a massive dent in your wallet. We expand on these below, or if you would prefer to watch our video version of this article, you can view it right here:
In This Article
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How To Appeal A Declined Wheelchair Request From Medicare
You can file an appeal if you disagree with Medicares coverage or payment decision. If Medicare declines your wheelchair request, pays less than 80% payment, or what you believe is your fair share, filing an appeal is the best course of action.
To file an appeal, you have to review the Medicare Summary Notice and follow the instructions written behind the document. If you have
After you file an appeal, the original decision will be reviewed and revisited. If your appeal doesnt decide in your favor, it can be reviewed by an independent organization.
You must know that your appeal must be filed within 120 days of receiving the MSN.
