How do I get Medicare to cover my power wheelchair?
The first step is to speak with your doctor! You may feel you need one, or your doctor might suggest a power wheelchair, but either way, you must have an office visit with your doctor before you can have Medicare cover a power wheelchair. The visit should take place no more than 45 days before the power wheelchair is ordered and should address the medical reasons you need the wheelchair. Your provider must sign an order or fill out a prescription for the power wheelchair that states:
- Your health makes it very hard to move around in your home, even with the aid of a walker or a cane.
- You have problems in your home with activities with daily living such as getting to the bathroom, getting in and out of your bed or chair, and with 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 order or prescription from your provider, you must take it to the correct supplier to ensure your power wheelchair is covered by Medicare. The supplier you use depends on what kind of Medicare you have and where you live.
If you have Original Medicare Part A & Part B, 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 more information and to see if you reside in a “competitive bidding area” visit www.medicare.gov/supplier or call 800-MEDICARE.
In 19 states, Original Medicare, your provider or supplier, will need to ask Medicare for permission, or receive prior authorization before you can get a power wheelchair covered by Medicare. If you live in one of the following states, you will need to take the necessary steps to obtaining prior authorization: AZ, CA, FL, GA, IL, IN, KY, LA, MD, MI, MO, NJ, NY, NC, OH, PA, TN, TX and WA.
Additionally, if you have Medicare Advantage (Part C), you will need to follow your plan’s rules for getting a power wheelchair covered by Medicare. Your plan might require you to get its approval before you get your wheelchair. It may also require you to use a supplier within the plan’s network. Your plan may even have a preferred list of brands for a power wheelchair or scooter. Preferred brands by a plan will cost you the least while you’re a member of the plan, so you should use the preferred brands if and when possible. You can contact Medicare Pathways to help you find out what you must do to get your power wheelchair covered by Medicare.
Do you have more questions about how to get your power wheelchair covered by Medicare? Give us a call at 866-466-9118 to get answers to your Medicare questions!