If you’re enrolled in Medicare and have an injury or illness 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 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
- dressing yourself
- whether or not you’re able to use the bathroom
These are all acceptable reasons for requesting DME.
It’s essential for you to communicate what limitations you’re facing with your doctor clearly. This will ensure that you’re prescribed the correct type of device.
Medicare Approved Wheelchairs & Mobility Scooters
- Manual wheelchair
- Power-operated vehicle/scooter
- Motorized wheelchair
A manual wheelchair is just a traditional wheelchair that you or someone else must push.
This option requires you to have the upper body strength to be able to push yourself safely.
Or that you have someone available to help you safely get around the house in the wheelchair.
Power Operated Vehicle/Scooter
If 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.
Your physician will need to state that you require a power scooter to get around inside your home and perform your daily activities.
You must be able to operate the scooter and its controls safely, as well as 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 face-to-face exam.
Prior Authorization of Certain Equipment
You may be impacted by a Medicare program called “prior authorization.”
In this scenario, your supplier will need to:
- Request prior authorization
- Send the required documents to Medicare and include the request
Currently, there are only two power wheelchairs that require prior authorization:
- K0856: Power wheelchair, group 3 std., single power option, sling/solid seat/back,
patient weight capacity up to and including 300 pounds
- K0861: Power wheelchair, group 3 std., multiple power option, sling/solid seat/
back, patient weight capacity up to and including 300 pounds
Out of Pocket Costs
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 a 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.
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. However, with a Medigap plan, you can alleviate out of pocket medical fees.
Does Medicare Advantage Cover Wheelchairs or Scooters
Medicare Advantage plans are 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 provided 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 coverage for any out of pocket costs associated with the price of a wheelchair or scooter.
Since supplement plans cover the gaps in Medicare coverage, having the right plan can protect your finances.
The right supplement plan paired with both Medicare Part A and Part B can help pay for a wheelchair or scooter. To get help choosing the right Medigap plan, give us a call today at the number listed above. You can also compare rates online by completing our rate form here.