If you’re enrolled in Medicare Parts A and B and have recently suffered an injury or been diagnosed with a disability causing limited mobility, you may be covered for a wheelchair or power-operated scooter.
Medicare considers these devices as Durable Medical Equipment, or DME, and will only cover one of these for in-home use.
Medicare and Wheelchair Coverage
To get started, you’ll want to schedule an appointment with your primary care doctor. Or another doctor that is currently treating you. During this face to face appointment, you’ll want to discuss all of your mobility challenges. Explain why you feel you need a wheelchair.
Being unable to do normal day to day activities inside your home, such as:
- getting up out of the bed
- being able to get dressed
- whether or not you’re able to use the bathroom
These are all acceptable reasons for requesting durable medical equipment.
It’s important for you to clearly communicate what limitations you’re facing with you, doctor. This will ensure that you’re prescribed the correct type of device.
What Types of Wheelchairs are Available through Medicare?
There are three types of wheelchairs:
- Manual wheelchair
- Power operated vehicle or scooter
- Motorized wheelchair
A manual wheelchair is just a traditional wheelchair that you or someone else must push. This option requires that you to have the upper body strength to be able to safely push yourself. Or that you have someone available to help you safely get around the house in the wheelchair.
There are a few more requirements to receive benefits for a power-operated vehicle or scooter.
If you think you need a power scooter because you lack the upper body strength necessary to operate a manual wheelchair, your primary care physician will need to certify that you have a medical condition limiting your mobility and you require a power scooter to get around inside your home and perform your daily activities.
You must be able to safely operate the scooter and its controls. As well as have the ability to safely get in and out of the scooter unless you have someone that can assist you.
The final type of wheelchair is a motorized or electric wheelchair. If you can not operate a manual wheelchair, but you do not qualify for Medicare Coverage for a power operated scooter, you may be eligible for this option. Your doctor will need to submit this order after your in person exam.
Once the correct wheelchair is prescribed for you, you will have a few more things to consider before finalizing your durable medical equipment benefits.
How Much Will A Powered Scooter Cost Me?
If you qualify for a power scooter, you pay 20% of the allowable charges for your equipment plus any applicable deductible. On average the price of motor powered scooter is between $700-$2000 so the total cost of the scooter may vary.
Also, depending on where you live, your equipment may be subject to Medicare’s 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 result in a lower cost.
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. Be sure to discuss the length of time you will need the wheelchair with your prescribing doctor.
Original Medicare Part B only pays for a portion of the total cost on your device. Meaning there will 20% of that cost left for you to pay, out of pocket.
In addition, you’re required to pay your Part B deductible before your policy coverage kicks in. Medicare (Part A and Part B) do not cover all of your medical expenses. However, there’s ways to alleviate the pain caused by out of pocket medical fees, like a Medigap plan.
Does Medicare Advantage Cover WheelChairs or Scooters?
Medicare Advantage Plans, or Medicare Part C, is required to offer you at minimum the same benefits Original Medicare does, except hospice care.
This means that Medicare Advantage plans must offer you the same 80% coverage on a wheelchair that traditional medicare does. However, they’re offered by private insurance companies and the copayments and deductibles can vary.
Will Medigap Cover the Cost of a Wheelchair or Scooter?
Medicare Supplement Plans can provide help with the additional cost caused by your need for a wheelchair or scooter.
Since Medigap plans are designed to cover the benefit gaps in your Traditional Medicare coverage and work alongside Parts A and B, having the right supplement plan can alleviate you having to pay anything at all.
For example, at least one Medigap Supplement plan pays ALL of your Part B deductible. As well as the 20% coinsurance and copays.
The right supplement plan paired with both Part A and Part B Medicare can pay for a wheelchair or scooter in full, with no cost to you. To get help choosing the right Medigap plan, give us a call today at the number listed above. You can also compare Medigap rates online by completing our rate form here.