Medicare Part B, which covers medical services and supplies, includes coverage for wheelchairs and power-operated vehicles (scooters) categorized as durable medical equipment (DME) when prescribed by your doctor for home use.
Here are key points to know about Medicare coverage for wheelchairs and scooters:
- Doctor’s Prescription: Before Medicare covers the cost of a power wheelchair or scooter, you must undergo a face-to-face examination with a doctor or treating provider. Following this examination, your doctor must provide a written prescription for the equipment. Medicare covers power wheelchairs only when they are deemed medically necessary.
- Costs in Original Medicare: After you meet the Part B Deductible, you are typically responsible for paying 20% of the Medicare-Approved Amount if your equipment supplier accepts assignment. The specific payment details may vary depending on the type of DME.
- Renting or Buying: Depending on the type of equipment, you may need to either rent or purchase it. In some cases, you may have the option to choose between renting and buying.
- Supplier Enrollment: Medicare will only cover your DME if both your doctors and DME suppliers are enrolled in Medicare and meet the program’s stringent standards. If they aren’t enrolled, Medicare won’t pay their claims. Before obtaining DME, it’s crucial to ensure that your doctors and suppliers are Medicare-enrolled. Additionally, ask your supplier if they participate in Medicare. Participating suppliers are required to accept assignment, meaning they can only charge you the coinsurance and Part B deductible for the Medicare-approved amount. Non-participating suppliers have no such restrictions on charges.
- Cost Estimation: To determine the precise cost of your test, item, or service, consult with your doctor or healthcare provider. Several factors can influence the amount you owe, including other insurance coverage, your doctor’s fees, their acceptance of assignment, the type of facility where you receive the service, and more.
- Prior Authorization: For certain power wheelchair, Medicare may require prior approval, often referred to as “prior authorization,” before covering the cost. Your DME supplier typically handles this process on your behalf, including submitting the prior authorization request and required documents to Medicare. Medicare will review the information to ensure your eligibility and compliance with the requirements for power wheelchair coverage. If your request is denied, it could be due to Medicare determining that you don’t medically require a power wheelchair or insufficient information to make a decision. In such cases, your DME supplier may resubmit the prior authorization request.
Understanding these Medicare guidelines is crucial when considering the coverage and costs associated with wheelchairs and scooters to ensure you receive the appropriate equipment and manage expenses effectively.