This article was updated on January 4, 2021.
Did you know that Medicare will cover expenses for power wheelchairs and scooters? As long as your doctor rules it as medically necessary, Medicare will help.
Original Medicare
If you have Original Medicare, some suppliers Medicare has approved for you will depend on how Medicare pays for equipment in your area and the kind of Durable Medical Equipment (DME) that you need. In some areas, you can use any supplier that has signed up with Medicare, in others you can only use specifics chosen by Medicare. Remember to find out if the competitive bidding demonstration affects you since it decides the suppliers you can use and the amount you will pay.
If your supplier accepts the assignment, you pay 20 percent of the Medicare-approved amount, and the Part B deductible applies. Medicare pays for different kinds of DME. Depending on the type of equipment it covers,
- You may need to rent the equipment.
- You may need to buy the equipment.
- You may be able to choose whether to rent or buy the equipment.
Medicare Advantage
If you have a Medicare Advantage plan, you must follow the plan’s rules for getting a wheelchair or scooter.
- The plan may require you to get its approval before you get your DME.
- It may require you to use suppliers in the chosen network. You may get little or no coverage if you use suppliers outside of the network.
- Your plan may have a list of preferred brands of power wheelchairs and scooters. These brands will cost you the least while you are a plan member.
If you need a power wheelchair or power scooter, you will need to follow these two steps to get Medicare to cover the expenses:
Start with your doctor. If you think you need a power wheelchair or scooter, ask your doctor. Before you get a wheelchair or scooter, you must have an office visit with your doctor. The visit should take place no more than 45 days before the DME order and should deal with the medical reasons you need the wheelchair or scooter.
Your provider must sign an order or fill out a prescription or certificate that states that you need the power wheelchair or scooter to function in the home.
The order must state:
- Your health makes it hard to move around in your home.
- You have problems in your home performing activities of daily living.
- If you need a power wheelchair, you cannot use a manual wheelchair or scooter, but you can use a power wheelchair.
- The required office visit with your doctor took place.
Use the Right Supplier. Once you have the doctor’s order or prescription, you must take it to the right kind of supplier to get coverage. The kind of Medicare coverage you have and where you live will decide which supplier you use for coverage.
Competitive Bidding Program
If you live in certain areas, you may be affected by Medicare’s Competitive Bidding Program. In most cases, Medicare will only help pay for equipment and supplies if they’re provided by contract suppliers.
Contract suppliers can’t charge you more than 20 percent coinsurance and any yearly deductible for equipment or supplies included in the Competitive Bidding Program. Under Medicare rules, you own these types of equipment after renting for 13 months.
Once you own the equipment, you must get replacement supplies and accessories from a contract supplier in order for Medicare to help you pay for them. You may get repairs for the equipment you own from any Medicare-approved supplier, including replacement parts needed for the repair.
