Written by Brian B

Does Medicare Pay For Wheelchairs?

Does-Medicare-Cover-Wheelchairs

Medicare.gov states that Medicare Part B (Medical Insurance) will cover power-operated vehicles, which includes scooters and manual wheelchairs, when prescribed for at-home use by a doctor. However, you must meet face-to-face with a doctor or other treating provider and receive a prescription before Medicare will pay for the wheelchair.

Original Medicare Costs

If your supplier accepts the assignment, you will likely be responsible for paying 20% of the Medicare-Approved Amount. The Part B deductible applies here, as Medicare will pay for different types of durable medical equipment (DME) in some different ways.

For example, buying or renting the equipment will undoubtedly impact how much coverage will be provided by Medicare. Medicare only covers medical equipment if both your doctor and medical supplier are currently enrolled in Medicare. Doctors and suppliers must always meet strict standards in order to stay enrolled in this program. No coverage will be provided if neither are currently enrolled.

Always make sure to know ahead of time if your doctor and supplier are enrolled in Medicare. Participating suppliers must meet assignment, which means they can only charge a patient for coinsurance and the Part B deductible for the exact amount that’s been approved by Medicare. This essentially means there is no limit on what suppliers are able to charge a patient when they are not enrolled in Medicare.

Medicare Approvals And Denials

In September of 2018, it was ruled that all patients must receive “prior authorization” for different kinds of power wheelchairs. Currently, there are 40 types of wheelchairs that require this approval – check out the full list right here. Prior authorization is needed before Medicare will approve covering the cost of the wheelchair.

DME suppliers need to do the following before receiving approval:

  • Request prior authorization ahead of time.
  • Submit said request and other required documentation to Medicare.

The patient generally does not have to do anything at this point of the process. The supplier is responsible for all the work detailed above. The specific DME supplier will need to send the request for authorization, including all documentation to Medicare on the patient’s behalf. Medicare will then review the request to ensure the patient is eligible for coverage.

Ultimately, coverage could be denied due to the following reasons:

  • Medicare says that you do not need a power wheelchair.
  • Medicare did not receive sufficient documentation.

Average Wheelchair Costs

Manual, transport, and electric are the three main types of wheelchairs. Costs for these wheelchairs can range all the way from $90-$9,000, depending on the type. Prices vary based on model, with the transport being the least expensive version.

Here are some average costs associated with wheelchairs today:

  • Average Transport Wheelchair Cost: $955.
  • Average Manual Wheelchair Cost: $1,400.
  • Average Electric Wheelchair Cost: $3,750.

*Please note these are cost estimates according to Braunability

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