How do I get Medicare to cover a power wheelchair?

Emily WhicheloeDear Marci0 Comments

Dear Marci,

I think I need a power wheelchair to get around my home. How do I get one, and how do I get Medicare to cover it?

Jacob (Concord, NH)

Dear Jacob,

The first step to getting a power wheelchair is to speak with your doctor. You may feel you need one, or your doctor might suggest it, but either way, you must have an office visit with your doctor before you get your wheelchair. This visit should take place no more than 45 days before the order is placed, and should address with the medical reasons you need the wheelchair. Your provider must sign an order or fill out a prescription that states:

  • Your health makes it very hard to move around in your home, even with the help of a walker or cane
  • You have significant problems in your home performing activities of daily living such as getting to the toilet, getting in and out of a bed or chair, bathing, and/or dressing
  • You cannot use a manual wheelchair or scooter, but you can safely use a power wheelchair
  • The required visit with your doctor took place

Once you have the doctor’s order or prescription, you must take it to the right kind of supplier in order to get your power wheelchair covered. The supplier you use depends on what kind of Medicare coverage you have and where you live.
If you have Original Medicare, the kind of supplier you can use will depend on where you live. In many areas, called competitive bidding areas, Medicare will only pay for most durable medical equipment (DME) from a select group of suppliers known as contract suppliers. In other areas, you can use any supplier that has signed up with Medicare. To find out whether you live in a competitive bidding area and which Medicare suppliers you can use, call 1-800-MEDICARE or visit www.medicare.gov/supplier.

Additionally, in 19 states, if you have Original Medicare, your provider or supplier will need to ask Medicare for permission before you can get a power wheelchair or scooter. This is called prior authorization. Click here to find out if you live in one of these states, and how to request prior authorization and/or appeal if prior authorization is denied.

If you have Medicare Advantage, you must follow your plan’s rules for getting a wheelchair or scooter. Your plan might require you to get its approval before you get your wheelchair. It may also ask you to use suppliers that are in your plan’s network. Your plan may also have a list of preferred brands of power wheelchairs and scooters. These brands will cost you the least while you are a plan member, so you should use preferred brands when possible. Call your plan to find out what you must do to get your power wheelchair covered.

-Marci

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