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Medicare helps people with several different areas of health care. One of these areas deals with medically necessary equipment and supplies, even when the patient is at home. Such medical equipment and supplies are known as Durable Medical Equipment (DME) and are covered under Medicare “Part B”.
Medicare helps people with several different areas of health care. One of these areas deals with medically necessary equipment and supplies, even when the patient is at home. Such medical equipment and supplies are known as Durable Medical Equipment (DME) and are covered under Medicare “Part B”.
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A common type of DME needed by patients at home are mobility devices, including wheelchairs. In recent times, the availability and usage of electric motorized wheelchairs has grown significantly. Medicare will partially cover the expense of this IF ALL of the conditions below are met. Medicare will cover 80% of the cost, if approved, and the patient will need to pay the other 20%. However, the patient’s annual deductible needs to be satisfied first. Please note that Medicare must approve the request to cover an electric wheelchair in advance in order for it to be covered.
A common type of DME needed by patients at home are mobility devices, including wheelchairs. In recent times, the availability and usage of electric motorized wheelchairs has grown significantly. Medicare will partially cover the expense of this IF ALL of the conditions below are met. Medicare will cover 80% of the cost, if approved, and the patient will need to pay the other 20%. However, the patient’s annual deductible needs to be satisfied first. Please note that Medicare must approve the request to cover an electric wheelchair in advance in order for it to be covered.
A Written Order From Your Doctor
You must obtain a written “order” from your physician which not only prescribes your need for an electric wheelchair, but also states the reasons that it is medically necessary for your particular situation. This order must also state why you need an electric wheelchair and that a manual regular wheelchair won’t suffice. This written order must be from a physician who is approved by Medicare and is issued after s/he has examined the patient in person, but not more than 45 days before getting an electric wheelchair.
Impacted Mobility
The patient’s officially diagnosed medical condition significantly impairs the patient’s ability to move around, even in their own home. This includes daily activities such as getting from one room to another, getting into or out of a chair and standing for even a short period of time.
Necessary For Daily Living Activities
The patient’s impacted mobility problems can only be properly and safely resolved with the use of an electric wheelchair – and that a walker, cane or regular wheelchair will not be adequate. Also, the electric wheelchair must be medically necessary for daily activities in the home and not only for activities that involve leaving the house.
A Compatible Residence
The patient’s home must be “wheelchair friendly”. This means there can be no stairs or narrow doorways in the home that will prevent the patient getting from one area of the home to another. Of course, if there are wheelchair ramps in addition to any interior steps, that will be satisfactory.
Ability to Safely Operate
The patient must be physically and mentally competent and able to safely operate the electric wheelchair in their home or have secured the services of an in-home aid to assist them. Conditions like blindness, severe mental impairment or paralysis would be examples of disqualifying conditions.
Approved DME Supplier
The electric wheelchair can only be obtained from a Medicare approved and participating DME supplier and only after Medicare issues an official approval of covering (partially) the expense. The supplier has the right to limit the particular models made available under Medicare coverage and the patient can shop around from different approved suppliers.
