If you need a manual wheelchair, follow these two steps to get Medicare coverage.
1. Start with your doctor. If you think you need a manual wheelchair, ask your doctor about it. Or, your doctor may be the one to recommend a manual wheelchair to you.
In any event, starting July 1, 2013, you must have a face-to-face visit with your doctor or other health care provider before Medicare will cover your DME. The visit should happen no more than 6 months before your doctor prescribes or orders your manual wheelchair and should deal with the medical reasons you need the manual wheelchair. Your order for the manual wheelchair must include a statement
Your provider must sign an order or fill out a prescription or certificate that states that you need the manual wheelchair to function in the home. The order must say that:
- 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 a chair, bathing, and dressing and
- You can safely use the wheelchair yourself or always have someone with you to help you use it and
- A statement from your doctor confirming that you the required office visit took place.
Keep in mind that the equipment must be necessary for you in the home but you can also use it outside the home. You can get only one piece of equipment at a time to address your mobility problem. Your doctor or other provider will determine what equipment you need based on your condition, what equipment can be used in your home, and what equipment you are able to use.
2. Use the Right Kind of Supplier Once you have the doctor’s order or prescription, you must take it the right kind of supplier to get coverage. Be sure to only use suppliers with approval from Original Medicare or your Medicare Advantage Plan.
If you have Original Medicare, be aware that the type of suppliers Medicare has approved for you will depend on how Medicare pays for equipment in your area and the type of DME you need. In many areas called, competitive bidding areas, Medicare will only pay for standard wheelchairs from a select group of suppliers known as contract suppliers. Call 1-800-MEDICARE or go to www.medicare.gov/supplier to get a list of suppliers Medicare has approved for you. Remember to find out if the competitive bidding demonstration affects you since it decides the suppliers you can use and the amount you will pay.
Also, if you live in or plan to travel to a competitive bidding demonstration area and (need DME that is included in the demonstration), make sure you are informed about the types of suppliers you must use and your costs for DME.
If you live in an area that is not part of the competitive bidding demonstration, you may need to rely on different kinds of suppliers.
If you have a Medicare Advantage Plan (like an HMO or PPO), you must follow the plan’s rules for getting a wheelchair.
- The plan may require you get its approval before you get your DME.
- It may also ask you to use suppliers in the plan’s network. You may get little or no coverage if you use suppliers outside of the plan’s network.
- Your plan may also have a list of preferred brands of wheelchairs. These brands will cost you the least while you are a plan member. Make sure you use preferred brands when possible to limit your costs.
Call your plan to find out what you must do to get your wheelchair covered. People in Medicare Advantage Plans will not be affected by the competitive bidding demonstration.