Wheelchairs & scooters

Medicare Part B (Medical Insurance)

covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home.

You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair. Part B covers power wheelchairs only when they're

medically necessary

.

Your costs in Original Medicare

If your supplier accepts

assignment

you pay 20% of the

Medicare-Approved Amount

, and the Part B

deductible [glossary]

applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:

You may need to rent the equipment.
You may need to buy the equipment.
You may be able to choose whether to rent or buy the equipment.

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.

Make sure your doctors and DME suppliers are enrolled in Medicare. It’s important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment (which means, they can charge you only the coinsurance and Part B deductible for the Medicare‑approved amount). If suppliers aren’t participating and don’t accept assignment, there’s no limit on the amount they can charge you. Medicare won’t pay claims for doctors or suppliers who aren’t enrolled in Medicare.

note:

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

Other insurance you may have
How much your doctor charges
Whether your doctor accepts assignment
The type of facility
Where you get your test, item, or service

Things to know

Starting September 1, 2018, you may have to get prior approval (known as “prior authorization”) for certain types of power wheelchairs. Under this program, 40 types of power wheelchairs require “prior authorization” before Medicare will cover the wheelchair cost.

Your DME supplier will need to:

Request “prior authorization”
Send the request and required documents to Medicare

You don’t need to do anything. If your physician prescribes one of these wheelchairs to you, your DME supplier will, in most cases, submit a prior authorization request and all documentation to Medicare on your behalf. Medicare will review the information to make sure that you’re eligible and meet all requirements for power wheelchair coverage. Your Medicare coverage and benefits will stay the same, and you shouldn’t experience delays getting the items you need.

Your prior authorization request may be denied if:

Medicare finds you don’t medically require a power wheelchair
Medicare doesn’t get all the information needed to make a decision

If additional information is needed, your DME supplier may resubmit your prior authorization request.

For more information, call us at 1-800-MEDICARE.

Wheelchairs & scooters

note:

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