If you need a power wheelchair or power scooter, follow these two steps to get Medicare coverage.
1. Start with your doctor. If you think you need a power wheelchair or scooter, ask your doctor about it. Or, your doctor may be the one to recommend a wheelchair or scooter to you.
In any event, before you get your wheelchair or scooter, you must have an office visit with your doctor. The visit should take place no more than 45 days before the DME order and should deal with the medical reasons you need the wheelchair or scooter.
Your provider must sign an order or fill out a prescription or certificate that states that you need the power wheelchair or scooter to function in the home. The order must state:
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;
- If you need a power wheelchair, you cannot use a manual wheelchair or scooter, but you can safely use a power wheelchair and
- The required office visit with your doctor took place.
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 to address your at-home 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 to the right kind of supplier to get coverage. Be sure only to use suppliers with approval from Original Medicare or your Medicare Advantage Plan. What kind of Medicare coverage you have and where you live will decide which supplier you use.
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 kind of DME you need. In many areas, called competitive bidding areas, Medicare will usually only pay for most DME from a select group of suppliers known as contract suppliers. In other areas, you can use any supplier that Medicare has signed up with Medicare. Call 1-800-MEDICARE or go 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 or scooter.
- 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 power wheelchairs and scooters. 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 or scooter covered. People in Medicare Advantage Plans will not be affected by the competitive bidding demonstration.