What's the deal with Medicare covering medical equipment like wheelchairs- do I need a special approval?
Answered by 11 licensed agents
Most items that are covered under durable medical equipment by Medicare Will have a 20% copay to the member. Certain items such as a wheelchair with customizations may require a doctor's prescription and others, for example a shower chair, would not require a prescription. If you are enrolled in a Medicare Advantage plan you will want to check with the plan to ensure that you are using an in-network supplier to keep your cost at the lowest possible rate. And oftentimes places like senior centers will have received donations for things like transport chairs, walkers, shower chairs that you can borrow.
Medicare Part B covers durable medical equipment (DME) like wheelchairs when deemed medically necessary, but you must have a doctor’s prescription and obtain prior approval from Medicare to confirm it meets their criteria, such as being essential for use within your home. This includes items supplied by Medicare-approved DME providers, though many beneficiaries don’t realize this until a need arises, often prompting a last-minute call to advisors for clarification. Without proper approval, coverage won’t apply, and you’d face full costs, so verifying these requirements early is key.
Your doctor starts that process. If you have a Medicare Supplement and already met your deductible then it pays for it. If your on a Medicare Advantage Plan, it pays 80% leaving you 20% to pay.
Medicare does cover durable medical equipment (DME), including wheelchairs, but there are specific requirements. Generally, Medicare Part B will cover medically necessary DME if prescribed by a doctor for use in the home.
Your doctor does a prescription for durable medical equipment and supplies such as oxygen, wheelchairs, a CPAP, etc. They just use a prescription to show the equipment would be medically necessary and appropriate for you.
Yes - your doctor needs to write an order for this and/or any durable medical equipment that would help you at home. If you don't get one from the doctor you can figure on paying for most of the cost out of pocket.
You can't just go out and say, "I need a wheelchair." There needs to be a prescription from a doctor typically. Medicare does cover it, but not at 100%. Depending upon the type of Medicare plan, there could be some out-of-pocket.
Yes, it needs to be medically necessary. See your family physician. They can help you provide a letter so that you can get any durable medical equipment that is covered by Medicare. And yes that would include wheelchairs and even motorized wheelchairs
You will require a preauthorization ordered from your doctor. You will be responsible for 20% of the cost under original Medicare Part B after the $255 Part B Deductible is met or a Medicare Advantage plan
