Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that only your doctor may prescribe for use.
You must have an in-person examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair. Power wheelchairs are covered only when they are deemed medically necessary.
If your supplier accepts your assignment, you pay 20 percent of the Medicare-approved amount, and the Part B deductible will apply. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment that you need, you may need to rent or buy the equipment.
Doctors and suppliers have to meet certain standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.
It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are “participating” suppliers, they must accept the assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept the assignment. If suppliers don’t accept the assignment, there’s no limit on the amount they can charge you.
What to Know
As of September 1, 2018, you may have to get prior approval (known as “prior authorization”) for certain types of power wheelchairs. Under the new rule, 33 types of power wheelchairs require “prior authorization” before Medicare will cover the wheelchair cost.
Your DME supplier will need to:
- Request “prior authorization”
- Send the request and required documents to Medicare
You don’t need to do anything. If your physician prescribes one of these wheelchairs to you, your DME supplier will, in most cases, 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 power wheelchair coverage. Your Medicare coverage and benefits will stay the same, and you shouldn’t experience delays getting the items you need.
Your prior authorization request may be denied if:
- Medicare finds you don’t medically require a power wheelchair.
- Medicare doesn’t get all the information needed to make a decision.
- If additional information is needed, your DME supplier may resubmit your prior authorization request.