How do I contact Medicare about a power wheelchair request?
Medicare will send a decision letter to your power wheelchair supplier. You may contact your power wheelchair supplier about the decision, or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Also, your power wheelchair supplier may send you a decision letter. Why was my request denied?
Does Medicare pay for an electric wheelchair?
Medicare Part B covers electric wheelchairs under its Durable Medical Equipment (DME) coverage. However, to be approved for an electric wheelchair through Medicare you must meet certain criteria. You must meet all of the following requirements for Medicare to pay for an electric wheelchair:
Does Medicare Part B cover power wheelchairs?
Part B covers power wheelchairs only when they're Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. .
Do I qualify for a power-operated wheelchair?
If a cane or walker is no longer effective, a manual wheelchair may be appropriate, as long as you have enough upper body strength or someone to assist you. If you can’t operate a manual wheelchair, you may qualify for a power-operated vehicle. You must be able to get in and out of the scooter by yourself, and safely manage the controls.
How often does Medicare pay for power chair?
Medicare may cover a replacement power chair after it has reached its reasonable useful lifetime. Reasonable useful lifetime (RUL) is estimated at, but no fewer than, five years.
Are powered wheelchairs covered by Medicare?
Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters), walkers, and wheelchairs as durable medical equipment (DME). Medicare helps cover DME if: The doctor treating your condition submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home.
How Much Does Medicare pay for a wheelchair?
Medicare Part B pays 80 percent of the cost of a wheelchair after you have met your annual deductible. You will pay 20 percent of the cost in addition to your annual Medicare premiums. You may also have copay costs associated with any doctor visits necessary to get your wheelchair.
Does Medicare cover Group 4 power wheelchairs?
So, what is a Group 4 power wheelchair? Meets all of the basic power wheelchair criteria and: Additional Medicare requirements: The client requires the improved suspension to minimize pain and/or triggers of spasticity when driving over a variety of terrains and obstacles.
How do you write a prescription for a power wheelchair?
The 7-element written order must include:Beneficiary's (patient's) name.Detailed description of item that is ordered.Date of the face-to-face examination.Pertinent diagnosis/conditions that relate to the need for a power wheelchair.Length of time the patient will need the device.Physician's signature.More items...
What qualifies for a wheelchair diagnosis?
Which Diagnoses Qualify for Wheelchairs?Multiple Sclerosis (MS)ALS (AKA Lou Gehrig's Disease)Parkinson's Disease.Spinal Cord Injuries.Cerebral Palsy.Muscular Dystrophy.CVA (AKA stroke-related paralysis)Post-Polio Syndrome.More items...
Will Medicare reimburse me for a wheelchair?
A: Yes. Medicare Part B covers a portion of the cost for medically-necessary wheelchairs, walkers and other in-home medical equipment. (Medicare will not cover power wheelchairs that are only needed for use outside the home.)
What are the basic coverage criteria for a standard wheelchair to be covered by Medicare?
A standard hemi-wheelchair (K0002) is covered when the beneficiary requires a lower seat height (17" to 18") because of short stature or to enable the beneficiary to place his/her feet on the ground for propulsion.
How Much Does Medicare pay for a rollator?
In most cases, Medicare will pay 80% of the rolling walker costs. Be sure to check your supplemental insurance policy for the details of your plan that will cover whatever Medicare does not –minimizing as much out of pocket expense as possible.
What is a Group 2 power wheelchair?
What is a Group 2 power wheelchair? Compared to scooters/POVs, Group 2 power wheelchairs have a more durable and robust power base with improved battery life, lasting longer distances for a more active user. Group 2 power wheelchairs can also drive at increased speeds, up to ~4mph, compared to scooters/POVs.
What is a Group 5 power wheelchair?
They are Group 5 power wheelchairs, which are simply pediatric power bases. Group 5 Chair: Are designed for clients who are expected to experience significant growth within the life of the chair and who weigh <125 lbs (even though some pediatric power chairs accommodate weights up to ~165 lbs.)
What is a Group 3 power wheelchair?
Group 3 power wheelchairs are reserved for the severely impaired patient afflicted with diseases such as: Amyotrophic Lateral Sclerosis (ALS), spinal cord injuries resulting in quadriplegia, stroke (CVA) with hemiplegia, late stage Parkinson's, late stage Multiple Sclerosis (MS), cerebral palsy or Muscular Dystrophy.
Power Wheelchair Medicare Coverage Guide
Does medicare cover wheelchairs? More specifically, do they cover POWER wheelchairs?
Medicare-Approved Power Wheelchairs
Okay, so you’ve read all of the above and determined that Medicare will most likely pay for your power chair. What now?
Where to Shop for Medicare-Approved Electric Wheelchairs and Scooters
For the elderly who are struggling with their daily activities, choosing the best mobility assistive devices can give them newfound freedom.
FAQs
After you have met your annual deductible, Part B of Medicare covers 80% of the cost of your power wheelchair. And you pay the 20%, in addition to your annual Medicare premiums.
How much does Medicare pay for a wheelchair?
If you have Original Medicare, you will likely pay 20% of the Medicare-approved amount of the wheelchair after you have paid your Part B deductible. Medicare Advantage plans are required to provide at least the same benefits as Part A and Part B, but many offer additional coverage.
What does it mean to be in a wheelchair?
If an illness has limited your mobility, a wheelchair can mean the difference between independence and assisted living, especially if you need help performing activities of daily living, such as bathing and dressing. If you are eligible for Medicare because you are 65 years of age or older, or have a disability and receive Social Security benefits ...
What is Medicare Part B?
Medicare Part B, also known as medical insurance, covers durable medical equipment (DME).
Can you get a power wheelchair covered by Medicare?
A power wheelchair may be available and covered by Medicare if you have a face-to-face visit with a physician who writes a prescription for the equipment.
Do you have to get prior authorization for a wheelchair?
Starting on September 1, 2018, you may have to get prior approval ( known as “prior authorization”) for certain types of power wheelchairs. Under this program, 33 types of power wheelchairs require “prior authorization” before Medicare will pay for them. If your physician prescribes one of these wheelchairs, your DME supplier will usually submit ...
Can you use a manual wheelchair with a cane?
Depending on your specific needs, you may qualify for a manual wheelchair, power-operated scooter, or power wheelchair. If a cane or walker is no longer effective, a manual wheelchair may be appropriate, as long as you have enough upper body strength or someone to assist you.
Does Medicare require prior authorization for wheelchairs?
If your physician prescribes one of these wheelchairs, your DME supplier will usually submit a prior authorization request and all documentation to Medicare on your behalf. Medicare will review the information to make sure that you’re eligible and meet all requirements for the power wheelchair.
Getting Wheelchairs Covered by Medicare
Caitlin McCormack Wrights has over a decade of experience writing hundreds of articles on all things finance. She specializes in insurance, mortgages, and investing and relishes making dull subject matter gripping and everyday topics amazing. Caitlin has a bachelor's from Duke and a master's from Princeton.
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 won’t qualify as your home, but a long-term care facility would.
Renting vs. Buying
If your DME supplier is enrolled in Medicare, they’ll know outright if Medicare lets you buy or pays for you to rent a specific DME. Medicare typically pays for most durable medical equipment on a rental basis, and only buys inexpensive or routinely bought equipment such as walkers, blood sugar monitors, or complex rehabilitative power wheelchairs.
How To Get Medicare To Pay for Your Wheelchair
Medicare Part B pays for your wheelchair if a qualified practitioner prescribes it for use in your home and documents the medical necessity as per the coverage requirements. Here’s how the process works.
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 won’t pay for a wheelchair you believe you need, you may appeal the denial of coverage and get an independent review of your request.
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 won’t exceed the actual charge or fee Medicare sets for the item. 5
The Bottom Line
Wheelchairs and related DME supplies are important services covered by Medicare that enable individuals to complete activities of daily living and facilitate their recovery after a hospital stay.
How much does Medicare pay for an electric wheelchair?
The Cost of an Electric Wheelchair Through Medicare. If you are approved for an electric wheelchair through Medicare, you can expect to pay 20 percent of the Medicare-approved amount and Medicare will pay 80 percent of the cost. However, if you have yet to meet your deductible for the year, you will have to pay your Medicare Part B deductible ...
How long does it take to get an electric wheelchair?
It is important to give your written order or Certificate of Necessity to your DME provider as soon as possible, as you’ll need to make your electric wheelchair purchase within 45 days of receiving the order.
Do you have to use competitive bidding for wheelchairs?
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.
Can you get Medicare for a wheelchair in a home that has not been remodeled?
If your home has not been remodeled to accommodate a wheelchair making it through narrow door openings or up stairs, it won’t be covered. You have a Medicare-enrolled doctor and supplier: Both your physician and the DME supplier you work with must be enrolled in Medicare. In some states, you have to use a specific supplier for Medicare to pay ...
Does Medicare cover electric wheelchairs?
Medicare Part B covers electric wheelchairs under its Durable Medical Equipment (DME) coverage. However, to be approved for an electric wheelchair through Medicare you must meet certain criteria. You must meet all of the following requirements for Medicare to pay for an electric wheelchair:
Can you use an electric wheelchair privately?
You can safely operate an electric wheelchair: You need to be able to safely operate an electric wheelchair to have one approved through Medicare, or you’ll need someone to be available to help you use it. If you have a condition that would make it unsafe to use an electric wheelchair privately or publicly, such as blindness or deteriorating mental ...
Can a walker help with mobility?
Your condition hinders daily living activities: Your health condition hinders your daily living activities and the use of other assistive devices such as a walker or a cane cannot resolve your mobility challenges. This includes getting out of bed, getting dressed, or going to the bathroom.
How to get a power wheelchair?
The first step to getting a power wheelchair is to speak with your doctor. You may feel you need one, or your doctor might suggest it, but either way, you must have an office visit with your doctor before you get your wheelchair. This visit should take place no more than 45 days before the order is placed, and should address with the medical reasons you need the wheelchair. Your provider must sign an order or fill out a prescription that states: 1 Your health makes it very hard to move around in your home, even with the help of a walker or cane 2 You have significant problems in your home performing activities of daily living such as getting to the toilet, getting in and out of a bed or chair, bathing, and/or dressing 3 You cannot use a manual wheelchair or scooter, but you can safely use a power wheelchair 4 The required visit with your doctor took place
Can you move around with a walker?
Your health makes it very hard to move around in your home, even with the help of a walker or cane. You have significant problems in your home performing activities of daily living such as getting to the toilet, getting in and out of a bed or chair, bathing, and/or dressing.
Does Medicare pay for DME?
In many areas, called competitive bidding areas, Medicare will only pay for most durable medical equipment (DME) from a select group of supplier s known as contract suppliers. In other areas, you can use any supplier that has signed up with Medicare.
Can you use a manual wheelchair?
You cannot use a manual wheelchair or scooter , but you can safely use a power wheelchair. The required visit with your doctor took place. Once you have the doctor’s order or prescription, you must take it to the right kind of supplier in order to get your power wheelchair covered.
Do you have to ask Medicare for prior authorization?
Additionally, in 19 states, if you have Original Medicare, your provider or supplier will need to ask Medicare for permission before you can get a power wheelchair or scooter. This is called prior authorization. Click here to find out if you live in one of these states, and how to request prior authorization and/or appeal if prior authorization is ...