If you think you need a power wheelchair or scooter, first speak to your doctor or primary care provider (PCP) The primary care provider (PCP) is the doctor or other health care worker who manages your health care and gives you a referral to consult a specialist if you need it. In Medicare Advantage, many Health Maintenance Organizations (HMOs) require you to select a PCP and get their permission or referral before seeing a specialist. Preferred Provider Organizations (PPOs) and Private Fee-for-Service (PFFS) plans do not have this requirement. . If your PCP determines that it is medically necessary that you use a power wheelchair or scooter, they should sign an order, prescription, or certificate after a face-to-face office visit.
Note: Your provider must request prior authorization for Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. to cover certain power wheelchairs and scooters.
The order should say the following:
- Your health makes it very hard to move around in your home, even with the help of a walker or cane
- It is difficult for you to perform activities of daily living (such as bathing and dressing) in your home
- You cannot use a manual wheelchair or scooter but can safely use a power wheelchair or scooter
- The wheelchair will help with a specific medical condition or injury and be used in the home
- And, you had a face-to-face meeting with the doctor
- This meeting should take place no more than 45 days before the prescription is written.
Note: Keep in mind that you can only receive Medicare coverage for one piece of equipment that addresses at-home mobility issues. Your PCP will determine whether or not you need a power wheelchair or scooter or a different device based on your condition.
Once you have your PCP’s order or prescription, you must take it to the right supplier to get coverage. Be sure only to use suppliers with approval from Original Medicare or your Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan.