Medicare Wheelchairs Pay

Nov 06, 2022 By Susan Kelly

Wheelchairs are a type of durable medical device covered by Medicare Part B, the medical insurance program. In most cases, Medicare will pay for your wheelchair if your attending physician provides a written order indicating that you need one and that you have reduced mobility due to one or more of the following conditions:

  • A medical issue that makes it difficult for a person to move about their house.
  • Incapacity to do actions necessary for everyday existence
  • Having the capacity to use a wheelchair safely, including being able to get on and off the chair
  • A wheelchair supplier and a wheelchair provider both accept Medicare patients.
  • A physician or provider who has been to your house to confirm that it is OK for you to use a wheelchair there.

Power vs. Manual Wheelchairs

Both powered and manually operated wheelchairs are covered under Medicare Part B. However, not everyone will qualify for both of these programs. You will need a written declaration from your physician declaring that you need a wheelchair to be eligible for either a powered or a manual wheelchair. If your power wheelchair is considered essential for medical reasons, you will be eligible to have it reimbursed by insurance.

Buying vs. Renting

Renting or purchasing medical equipment can be an option for you, depending on the particulars of your circumstance. In certain instances, Medicare will choose the option it deems best suitable for your circumstances. In other circumstances, you could have the option of either purchasing or renting the property.

Canes and walkers are examples of low-cost medical devices that Medicare will often pay for. Renting is the default option for any other type of equipment. On the other hand, if you rent it for thirteen months without buying it, the arrangement will change from a rental to a purchase.

If you currently have a covered item, Medicare may also choose to purchase your necessary medical equipment on your behalf. If this is the case, Medicare could pay to fix your equipment or replace its components individually. Medicare may pay to replace your medical equipment if it is lost, stolen, or severely damaged beyond repair.

The Step-by-Step Guide to Having Medicare Pay for Your Wheelchair

Obtain a Written Order From Your Attending Physician

It should be stated in this written order that you are required to use the wheelchair due to a medical condition.

Request Prior Authorization

To begin, you must submit a prior authorization request to a medical equipment provider that Medicare approves. After you have completed those steps, you will next submit the prior authorization to Medicare so that they may make their ultimate determination.

Obtain Permission to Use Your Wheelchair

After you have provided Medicare with both your written order and your previous permission, you will be sent a decision letter stating whether or not your request has been granted. You may contact Medicare at 1-800-MEDICARE if you have any concerns regarding their decision or if you haven't gotten a letter from them.

How to File an Appeal After Being Denied Coverage

Medicare has the right to reject your request regardless of whether or not you have a documented order from your physician or previous permission from your provider. This might happen if Medicare determines that you do not have a medical need for a wheelchair or if they do not obtain sufficient information to make a determination.

If Medicare declines your request and you disagree with the decision, you may still choose between a few other courses of action. To begin, please reapply for your previous permission. If it does not work, you might try following the appeals procedure for Original Medicare.

Which Expenses Are You Responsible For Paying

Even if Medicare approves your request for a wheelchair, you will be responsible for paying part of the associated expenses. To begin, your deductible for the year must be satisfied before you may proceed. The deductible for Medicare Part B will be $233 in the year 2022. When your Medicare Part B deductible has been satisfied, your share of the cost of durable medical equipment, such as wheelchairs, will pay 20% of the total cost. Medicare will pay 20%, leaving 80% covered by other sources.

Bottom Line

Wheelchairs are a type of durable medical device included in the scope of coverage provided by Medicare Part B. You are eligible for this program if you have a medical condition requiring a wheelchair and a signed order for one from your attending physician. Whether you need a manual or electric wheelchair will determine whether the criteria are somewhat altered. Therefore, if you want to increase the likelihood that your request will be granted the first time you submit it, you should study the procedure beforehand.

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