Nebulizer Prescription RequirementsCrutchesDME & Home Health SupplierCanesDiabetic Insulin PumpsDiabetic SuppliesElectric Mobility ScootersHospital Bed RentalsManual WheelchairsMedical Alert SystemsMedical Equipment and Supplies Covered by MedicareWalkersNebulizersOstomy SuppliesPatient LiftsTraction EquipmentWheelchair Options and AccessoriesMedicare Part AMedicare Part BMedicare Part CMedicare Part DGuide to Medicare CoverageMedicare Coverage for specific type of home medical equipmentMedicare Supplier StandardsHealth IssuesMedical Supplies WheelchairMobility ProductsOther EquipmentBarringtonHighland ParkLake ForestNorthbrookSkokie Home » Buyers Guide » Manual Wheelchairs Will Medicare Cover Manual Wheelchairs? Yes, Medicare will cover manual wheelchairs. However, you must be able to show you have an honest medical need for a manual wheelchair and the primary use must be for moving around your home. In other words, it just can't be something that would be nice to have or primarily for use outside the home.
However, you must follow the steps below to ensure that Medicare pays for the equipment: Only your doctor can prescribe the equipment for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you. The doctor must document the need in your medical records and give you a signed and dated order (prescription) for the equipment. How Do I Qualify For a Wheelchair? You must have Medicare's part B coverage and you must have been assessed by your doctor, who documented your need in your medical record and wrote you an order (prescription) for the equipment. The supplier must have the order on file before billing for the chair. In addition, the need for the wheelchair must meet the following criteria: You cannot walk, even with the support of other mobility equipment (canes, walkers, etc.) You would spend most of your time in bed or in a chair without the use of a wheelchair You can transfer safely in and out of the wheelchair
Are able to sit and ride safely in the wheelchair and can operate the controls The primary reason for needing the item is to help you move about independently, not to prevent an injury from occurring where no injury or illness exists (even through it will help prevent injury, as well). The primary use will be inside the home. Although you can also use the wheelchair while outside the home, it may not be for use only when outside the home setting. Wheelchairs require a Certificate of Medical Necessity. Your Doctor and Medicare supplier will know when that documentation is required. Where Do I Go?Medicare Requires that you use a Medicare Contracted Provider for this service please Click Here and follow instructions to find the Medicare contracted providerHow much does it cost for Manual Wheelchairs? After you have paid your annual deductible, you will pay 20 percent of Medicare-approved amounts for the wheelchair purchase or rental and maintenance. Those costs may be higher if the supplier doesn't accept the assignment.
Wheelchairs are in the "Capped Rental" category which means you may choose to rent or purchase a wheelchair. Once Medicare has made 10 monthly rental payments you will be given an opportunity to purchase the wheelchair. The supplier will send you a 'Purchase Option' letter in the ninth month of the rental. You will have 30 days to reply. If you reply and want to buy the wheelchair: Medicare will make three more payments and the chairs is yours You will be responsible for maintenance (Medicare will cover 80 percent of the total maintenance cost). It is the patient's responsibility to find a Medicare approved supplier for the maintenance. If you do not answer or choose to continue renting: Medicare will make a total of 15 rental payments and the wheelchair is yours to use as long as you need it. The supplier keeps ownership of the chair and is responsible for maintaining it You will be charged a maintenance and service fee every six months. Medicare will pay 80 percent of the maintenance and service fee.
Where Do I Purchase Wheelchairs? You will save money if you order your items from a Medicare approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your wheelchair from any store that sells them. However, if the supplier from which you order your chair is not enrolled in Medicare, Medicare will not pay for the equipment. Things you should think about before you choose a supplier: There are two types of Medicare suppliers, participating suppliers and those who are enrolled, but have chosen not to participate. Participating suppliers must accept assignment, which means they agree not to charge more than the Medicare allowed amount. A Medicare approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the chair.
In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple months to receive payment. If you receive your Medicare coverage through a Medicare Advantage Plan (HMO or PPO), it is likely that the plan will have its own steps for the purchase. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers -- they cannot supply less. Depending on your plan you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan's customer service and ask about your coverage before you order your chair.User ReviewedHow to Get a Wheelchair Through Medicare Two Parts:Getting a Certificate of NecessityGetting Your WheelchairCommunity Q&A If you are on Medicare and you have suffered from a recent injury or disability, or are recovering from surgery, you might be eligible for a wheelchair benefit.
Older people who find their mobility has been compromised can also try to get a wheelchair with their Medicare Part B benefits. It does not take much to get a wheelchair from Medicare, just talking to a doctor and finding the right supplier.If you are over the age of 65, a US citizen, and having paid into Social Security through your job for at least 10 years, you are eligible for Medicare, the government's health care insurance plan. There are 4 plans in the Medicare program (Parts A, B, C, and D), which cover different aspects of your healthcare. Find a plan that works for you, and enroll during the open enrollment periods. You may already be covered. Once you apply for Social Security benefits, you will be automatically enrolled in Medicare Part A, which covers hospital care, and Part B, which covers medical services and supplies. These two parts together are sometimes called "Original Medicare." Part C, a healthcare insurance plan, and Part D, the prescription drug plan, require separate applications.
They don't have anything to do with getting a wheelchair, so no need to worry about them here. Schedule a doctor's appointment. Explain to your doctor why you need a wheelchair. Explain the specific issues you are having or tasks you cannot perform as a result of your condition. Provide your doctor with as much detail as possible in your answers. You will also want to be sure that a wheelchair will solve your issues, and not some other piece of equipment, like a cane, crutches, or a walker. Tasks that you cannot do along can be simple, everyday tasks. If you have trouble bathing, getting dressed, or using the bathroom, even with help, these are all acceptable reasons for needing medical equipment. Make sure you will be able to operate the wheelchair safely. A wheelchair is a substantial piece of equipment, and one that will take some time to use properly. You will need to be able to get in and out of the chair, as well as maneuver it around your home. If you cannot do this on your own, then you will need help.
You may need to find an assistant, whether a family member or professional nurse, to help you safely use your wheelchair. Decide on the wheelchair that is best for you. The Certificate of Necessity will have to note the type of wheelchair you need. In general, there are three different types of wheelchairs: a manual wheelchair, power-operated vehicle, or power wheelchair. A manual wheelchair is powered by you or someone else pushing it. If you have enough upper body strength to maneuver the chair, or you have someone able to push you around, you can qualify for a manual wheelchair. To qualify for a power-operated vehicle, or scooter, you need to demonstrate the strength and ability to sit up and operate the controls safely. You will also need to be able to get in and out of the vehicle safely, whether by yourself or with help. If you can't use a manual wheelchair, or don't qualify for a power-operated scooter because you cannot sit up or work the controls safely, you might qualify for a power wheelchair.
Your doctor will need to give you a face-to-face exam in order to submit the written order. Consider other features, such as folding easily to get in and out of the car. Determine whether you will be using your wheelchair indoors or outdoors (or both), and how many hours in the day you will be using it. Get the signed Certificate of Necessity. Check to make sure you have met your Part B deductible. Medicare will not pay for the wheelchair until you have met your deductible. In 2015, the deductible is $147.[1] This means you must have paid at least $147 of out-of-pocket medical expenses before the Medicare Part B coverage is applied to your wheelchair. The deductible can change every year, so make sure you have the most up-to-date information from Medicare, either through official paperwork they send you, or through their website: https://www.medicare.gov/your-medicare-costs/index.html. Know how much you are going to pay. Medicare will help cover your expenses, but it won't make the wheelchair free in most cases.
Assuming you meet the deductible, Medicare Part B will cover 80 percent of the wheelchair cost, meaning you will pay 20 percent. If you are unable to pay that 20 percent, you may be able to get additional assistance through the Medicare Savings Program. Payments are different in each state, so you will need to contact your state office to find out if you qualify, and how much money you can receive. Determine whether you should rent or buy your wheelchair. Rental can be cheaper in the short term, so you may choose to rent, rather than buy, your wheelchair. If you rent, Medicare will cover rental costs for up to 13 months. After 13 months, you will own the equipment. If you expect to use the wheelchair for a long time, buying up front may be cheaper after you account for a deposit and the rental payments. You should discuss the length of time you will need the wheelchair with your doctor, while you can discuss the payment options with the medical supplier. Find a supplier approved by Medicare.
Medicare will only pay for costs that they approve, so purchase your wheelchair at a medical supply store that is approved by Medicare. You can find those stores either by calling Medicare directly at 1-800-MEDICARE (1-800-633-4227) or searching through their online directory at https://www.medicare.gov/SupplierDirectory/. You are looking for a supplier that sells Durable Medical Equipment (DME). See if you are eligible for Medicare's Competitive Bidding Program. In certain parts of the country, Medicare will have suppliers submit bids to provide medical items, like wheelchairs, as a lower price. The Medicare website has a list of areas that are included in the program: https://www.medicare.gov/what-medicare-covers/part-b/competitive-bidding-program-areas.html#collapse-4767. This only applies for sure if you are covered under Original Medicare (Parts A and B). If you are enrolled in Part C, a Medicare Advantage Plan (such as an HMO or PPO), you will need to check with your plan to see if it is involved with the Competitive Bidding Program.
Once you have your Certificate of Necessity, call the company you want to purchase from within 45 days. They will send a representative to your house to measure and make sure you are getting the right model.[4] Once you have picked out the right chair, the supplier will make arrangements for delivery and payment. Show more unanswered questions If you need further help understanding your Medicare benefits, call the Medicare agency at 1-800-MEDICARE (1-800-633-4227), or visit the website at www.medicare.gov. If you are not eligible for Medicare assistance, you can still rent a wheelchair, which is a cheaper option than trying to buy one. Be cautious about fraudulent doctors and providers who attempt to offer high cost wheelchairs to people who do not qualify for them. If you are offered a free wheelchair, or a company wants to waive your copayment, you may be dealing with a dishonest provider. You should also be suspicious if you receive a bill for equipment you never received.