Are Electric Wheelchairs or Scooters Covered Under My Medicare?

If you have Medicare Parts A and B, there’s is a possible way in getting the durable equipment you desperately need

There definitely a way in getting the power wheelchair or durable medical equipment you desperately need for your wellbeing if you have Medicare Parts A and B. The cost of power operated scooters in New York City can range from 600 to over 7000 dollars. Not to many seniors, retirees, and people with disabilities who are in dire need of an electronic scooter can afford this exorbitant cost. More and more seniors are seeking help from their insurance, in particular Medicare, and assistance from their providers who can help give them some guidance and set their mind at ease. As many providers in New York City may not be informed about coverage options offered by Medicare, the process, and items that can be approved by Medicare, more seniors and their loved ones are yearning to find resources and information that can help them understand their Medicare benefits and how they can go about in getting the life quality items they desperately need.

Well, here’s some important news you should know about your Medicare health coverage

Power operated vehicles like scooters, wheelchairs, and other Durable Medical Equipment (DME) are actually covered through Medicare Part B. Medicare does cover the cost of Certain DME products, once granted approval, and they would usually cover 80 percent of the cost. Medicare does not cover the cost of a scooter or electric wheelchair 100 Percent. Once you receive the approval from Medicare for a covered DME product, your part of the cost would be 20 Percent after you pay for your yearly Part B deductible. It’s important to note that Medicare will only cover 80 percent of the cost, you or your provider must follow a defined process, and the covered DME product must be provided by a Medicare Approved Durable Medical Equipment Provider.

So, what is the actual process in betting a covered DME product like power scooters or wheelchairs?

Medicare has a particular process that providers must follow to get authorization for scooters, wheelchairs, and other covered DME products, along with specific details on the models, group, type and weight. Your treating physician or doctor must identify a condition requiring you to have a scooter or wheelchair, and they have to submit a written order stating that you have a medical need to use the items for your daily living.  If your doctor is treating you for a condition that requires a wheelchair scooter, the DME provider must be contracted with Medicare, and you must be enrolled in Medicare.

Before attempting to get a power wheelchair or scooter, ask yourself the following questions:

• Are able to safely operate the wheelchair or scooter?
• Are you able get on and off the wheelchair or scooter or have someone with you who is always available to help you safely use it?
• Are you unable to go about your daily activities, such as getting in or out of bed, using the bathroom dressing, or bathing, and have to use a cane or walker to get about?
• Can you not able to use a cane or walker, and can’t operate a manual wheelchair?
• Can you get in and out of the power operated scooter safely, be strong enough to sit up and safely operate the controls?

If you answered yes to all the questions, given these circumstances, you may qualify for a power-operated scooter once a request is submitted to Medicare. It’s important to keep in mind that the final decision is determined by Medicare.

How do you know if your request was approved?

Medicare will send a decision letter to your power wheelchair supplier. You may contact your power wheelchair supplier about the decision or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Also, your power wheelchair supplier may send you a decision letter.

What if you have Medicare Part A and B and have a Medicare Advantage Plan?

If you are on a Medicare Advantage Plan, you must use a durable medical provider which is in network with your plan, and follow the process described above.

What are the types of wheelchairs and models Medicare can approve, which require prior authorization?

Medicare has a defined list of power wheelchairs which require prior authorization before Medicare will pay for them. The Power wheelchairs (sling/solid seat/back) are categorized in a list by model, group, type and weight capacity.  If you are worried about the weight capacity, keep in mind that the maximum capacity can go up to 601 pounds or more, and they do cover “Extra Heavy Duty” power wheelchairs. Please follow this link to see the detailed list: Medicare’s Wheelchair & Scooter Benefit.

What if you receive a decision from Medicare, or your power wheelchair supplier stating that your request was not approved?

There are 5 possible reasons why Medicare may deny your request or not provide an authorization.

1. Medicare finds that you don’t medically require a power wheelchair based on the information you or your provider sent to them.
2. The Durable Medical Provider may not be contracted or approved by Medicare
3. There Medicare received only partial information and didn’t get all the necessary information needed to make a decision.
4. Your Medicare Part B is not Effective or was terminated
5. You haven’t met your Medicare Part B yearly deductible or didn’t pay for it.

We hope this article helped answer some of your questions about power operated Wheelchairs, how to go about in getting a power operated scooter, and a better understanding about the process in how to go about in getting such a crucial items which can help improve your quality of life. For more information, call Medicare, or follow this link to learn more: Medicare’s Wheelchair & Scooter Benefit.

Disclaimer: The information provided in this post is intended for informational use and does not constitute advice; instead, all information, content, and materials available on this site are for general informational purposes only.