People who require a wheelchair or another mobility device may wonder whether Medicare pays for part or all of the cost.
Medicare Part B provides coverage for necessary durable medical equipment (DME). Part B considers whether or not wheelchairs, scooters, and other devices that help with mobility can qualify as DME.
In order for their device to qualify for DME coverage, a person must make sure that:
- the device is medically necessary
- the prescribing doctor is enrolled in Medicare
- the device supplier is enrolled in Medicare
Read on for more information about Medicare Part B coverage for wheelchairs and other mobility devices.
Medicare Part B may cover one piece of DME that addresses in-home mobility issues. DME is medical equipment that helps people accomplish their day-to-day activities.
In addition to wheelchairs and scooters, DME may include:
- portable oxygen equipment
- hospital beds
- patient lifts
- traction equipment
A doctor may determine whether a person needs a manual wheelchair or a different mobility device based on their health status and everyday needs.
Manual wheelchairs and scooters
If a doctor determines that a manual wheelchair or scooter is medically necessary, they may create an order, certificate, or prescription.
The order usually mentions the following:
- The person’s health makes it difficult for them to move safely around the home, even with the assistance of a walker or cane.
- The person’s health makes it difficult for them to perform activities of daily living, such as dressing and bathing, in their home.
- The person can safely use the manual wheelchair themselves or will always have someone to assist them.
- The manual wheelchair can help with a specific medical condition or injury.
- The person had a face-to-face meeting with the prescribing doctor.
The face-to-face meeting should occur no more than 6 months before the doctor writes the order.
Once the person has the order, they should take it to a Medicare-approved DME supplier.
Powered wheelchairs and scooters
If a manual wheelchair or scooter is not suitable for a person, they should schedule an appointment with their doctor for an in-person consultation.
If the doctor determines that an electric wheelchair or scooter is medically necessary, they may write an order, certificate, or prescription.
Usually, a doctor must request prior authorization for original Medicare to cover certain types of powered wheelchairs and scooters.
In addition to the requirements of a regular order, the doctor will also state that the person does not have the ability to use a manual wheelchair or another mobility device and, therefore, requires an electric one.
In this case, the in-person meeting with the doctor should occur no more than 45 days before they write the order.
The person’s condition will determine a doctor’s decision on whether they require a powered wheelchair, powered scooter, or another mobility device.
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First, a person should make sure that their doctor and the DME supplier are enrolled in Medicare.
Doctors and DME suppliers have to meet strict standards to enroll and continue their enrollment in Medicare. If either one is not a Medicare enrollee or if neither is, Medicare may refuse to pay claims.
It is also vital for a person to ask the DME supplier whether or not they “participate” in Medicare. If they are a participating supplier, they must accept assignment.
Accepting assignment means that the supplier agrees to accept the Medicare-approved amount as payment for the service or product. They will send the bill to Medicare. As Medicare often pays only 80% of this approved amount for services, the person may be responsible for paying the remaining 20%.
If the DME supplier is enrolled but not participating, they can choose whether or not to accept assignment.
A person can consult a doctor to determine the out-of-pocket cost of a wheelchair or scooter. The amount owed may depend on several factors, including:
- the person’s other health insurance
- how much the doctor charges
- whether or not the doctor accepts assignment
- the type of facility
- where a person chooses to buy their DME
Depending on the type of wheelchair and the health condition that makes it medically necessary, a person may need to rent or buy the equipment. They may also be able to choose whether they want to rent or buy the equipment.
Medicare pays for 80% of the cost of a medically necessary wheelchair, scooter, or another mobility device. A person is responsible for the remaining 20% of the cost, along with any remaining deductible, copayment, or premium payments.
Before ordering a DME, the person’s doctor will need to submit an order explaining why the device is medically necessary, and the supplier will have to fill out any additional paperwork as necessary.
In addition, the person should confirm that both their doctor and the DME provider are participating in Medicare Part B before ordering the wheelchair, scooter, or another device.