Wheelchairs & scooters
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. Power wheelchairs are covered only when they're
.
If your supplier accepts
you pay 20% of the
, and the Part B
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.
It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.
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
Note
Starting September 1, 2018, you may have to get prior approval (known as “prior authorization”) for certain types of power wheelchairs. Under this program, 33 types of power wheelchairs require “prior authorization” before Medicare will pay for them.
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 the power wheelchair. 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.