Medicare Part B has a Durable Medical Equipment (DME) benefit that covers things like walkers, wheelchairs, CPAP machines, diabetic supplies, and more. However, Medicare has a specific process for determining coverage for each piece of durable medical equipment you need.
Generally, Medicare will cover the least expensive option that meets your medical needs. You will have to meet specific criteria for any upgraded versions of durable medical equipment.
Electric wheelchairs are an upgraded version of manual wheelchairs. While Medicare does cover electric/power wheelchairs, you have to clear a few hurdles before they pay.
How to Qualify For an Electric Wheelchair under Medicare
Medicare Part B only covers durable medical equipment that is prescribed by your doctor, so that’s the first requirement.
For Medicare to cover a manual wheelchair, you need to meet the following requirements:
- You’ve been diagnosed with a medical condition that makes it difficult to move around your home.
- You aren’t able to bathe, dress, use the bathroom, or perform other activities of daily living, even with the help of other durable medical equipment such as a cane or walker.
- You can operate and transition on and off the chair either by yourself or with the help of another who is always with you.
- Your home doesn’t have any obstacles that would make it difficult to use a wheelchair within (such as small doorways, stairs, etc.).
The next upgrade to a manual wheelchair is a power-operated scooter.
To qualify for this type of electric wheelchair, you must meet all of the requirements above, as well as:
- You aren’t able to safely operate a manual wheelchair.
- You must be strong enough to sit upon your own while on the scooter.
- You must be able to operate the scooter’s controls safely.
If you meet all of the criteria listed above, but you aren’t strong enough to sit up on a scooter by yourself, then you may qualify for a power wheelchair. A power wheelchair is usually needed if your disability limits your arm mobility and your strength to sit up on your own and propel yourself using your arms. A standing power wheelchair is recommended to help relieve pressure sores, edema, and spasticity.
If you qualify for a power wheelchair, your doctor will need to examine you to verify whether you can operate the wheelchair or not. Once your doctor has confirmed that you need a power wheelchair (i.e., that it’s medically necessary), he or she will have to submit documentation explaining to Medicare why you need the upgraded version rather than a manual wheelchair or power scooter.
How Medicare Covers Electric Wheelchairs
If Medicare approves your electric wheelchair, Medicare Part B will cover 80% of the Medicare-approved amount for the wheelchair after your annual deductible is met. Your responsibility is 20% of the cost of the wheelchair unless you have a Medigap plan that covers the Part B coinsurance for you. A secondary insurance generally covers some or all of the costs above the Medicare-approved amount.
A Redman Power Chair is a complex rehabilitation chair. Specifically it is a multi-option group 3 power wheel chair and it is the only power chair that is purchased via Medicare. All other power chairs are capped rental under Medicare guidelines. Note that Medicare will require you to have a face to face encounter with your physician who writes a prescription for the wheelchair.
Electric Wheelchairs That Require Prior Authorization
Medicare uses the term prior authorization when a device, medication, or service needs to be approved through Medicare before it is obtained. All power devices require prior authorization through Medicare, and a Redman Power Chair is no exception; it does indeed require a prior authorization.
As long as your doctor sends detailed information proving that you are in medical need of this wheelchair, then your prior authorization should be approved. However, Medicare may request additional documentation before they make their final decision.
Although the process can be grueling, Medicare will cover electric wheelchairs when medically necessary. Fortunately, Redman Power Chair has their own in-house insurance department and has accepted Medicare since its inception in 1966. Just be patient with the process and supply the necessary documents, and the process should move along smoothly.
