For Medicare beneficiaries with mobility concerns, having a wheelchair can be key to quality of life. Medicare provides coverage for wheelchairs through its durable medical equipment benefits under Medicare Part B.
Medicare has two original parts. Medicare Part A pays for your hospital services and Medicare Part B covers outpatient medical services.
Let’s reviews how Part B covers benefits for DME like wheelchairs:-
Medicare’s Guidelines for Obtaining a Wheelchair
Medical equipment like wheelchairs can be pricey, so Medicare has criteria in place that must be met.
First, your doctor will need to write an order for your wheelchair. This order must state your medical need for a wheelchair in order for you to get around your own home. While you may need the wheelchair for activities and errands outside your home, this is not enough in Medicare’s eyes.
You’ll have six months from this doctor visit to fill your order for the wheelchair.
Second, your physician needs to list the specific health condition that causes your mobility problem. It needs to be a health condition that interferes with your ability to perform regular daily activities such as going to the bathroom or getting dressed.
Finally, your doctor must assess that you are able to safely operate a wheelchair, or that you have someone else in the home that can help you operate it safely.
Ordering Your Wheelchair from a DME Provider
To control spending, Medicare implemented a competitive bidding program several years ago. This program operates in certain areas throughout the country. In these areas, you will need to order your wheelchair from one of the approved vendors that participate in this program.
Fortunately, Medicare has a tool on their website that will help you to search for approved vendors in your area. Once you locate one that offers the model of wheelchair you need, your doctor can fax the order for the wheelchair to the DME vendor.
Your Part B benefits will pay for 80% of the cost your wheelchair. You must pay the other 20%. Be aware also that every year you have a Part B deductible which you must first meet before any Part B benefits will be paid. Currently, that deductible is $183.
If you’ve already paid the deductible earlier in the year, you won’t pay it again when you get your wheelchair.
Since paying 20% of all of your outpatient care could be quite expensive, most Medicare beneficiaries purchase a Medicare supplement insurance plan when they first become eligible for Medicare.
Supplements pay after Medicare and help to fill in the gaps. Depending on the plan you choose, it may pay for your deductibles, your copayments and your 20% coinsurance under Part B.
Plan F is the plan that currently offers the most benefits. It covers all of the gaps, leaving you with nothing to pay out of pocket on Part A or B services. When Medicare gets your claim, it will pay its 80% share and then send the rest on to your Medicare supplement insurance company to pay the rest.
Supplements are offered by lots of great insurance companies such as Aetna, Humana, United Healthcare, BCBS and many others.
If you enrolled in a Medicare Advantage plan instead of a Medicare supplement, your benefits will work differently. You will need to order your wheelchair from the durable medical equipment vendors who are in the network with your Medicare Advantage plan. What you pay for your share will be outlined in the plan’s Evidence of Coverage.
Danielle K Roberts is the co-founder of Boomer Benefits where her team helps thousands of Medicare beneficiaries with their supplemental choice every year.