Medicare Part B (Medical Insurance)covers wheelchairs and power-operated vehicles (scooters) as durable medical equipment (DME) that your doctor prescribes for use in your home.
You must have a face-to-face examination and a written prescription from treating provider before Medicare covers a power wheelchair or scooter. Part B covers power wheelchairs and scooters only when they're medically necessary.
Your costs in Original Medicare
After you meet the Part B deductible you pay 20% of the Medicare-approved amount (if your supplier accepts assignment). Medicare pays for different kinds of DME in different ways. Depending on the type of equipment: Make sure your doctors and DME suppliers are enrolled in Medicare. It’s also important to ask a supplier if they participate in Medicare before you get DME. If suppliers are participating in Medicare, they must accept assignment (which means, they can charge you only the coinsurance and Part B deductible for the Medicare‑approved amount). If suppliers aren’t participating and don’t accept assignment, there’s no limit on the amount they can charge you.
Find out cost
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
- Other insurance you may have
- How much your doctor charges
- If your doctor accepts assignment
- The type of facility
- Where you get your test, item, or service
Things to know
You may have to get prior approval (known as “prior authorization”) for certain types of power wheelchairsbeforeMedicarewill cover the wheelchair cost.
Your DME supplier should:
- Request “prior authorization”
- Send the request and required documents to Medicare
You don’t need to do anything. If your physician prescribes one of these wheelchairs to you, your DME supplier will usually submit a prior authorization request and all documentation to Medicare on your behalf. Medicare will review the information to make sure that you’re eligible and meet all requirements for power wheelchair coverage. Your Medicare coverage and benefits will stay the same, and you shouldn’t experience delays getting the items you need.
Your prior authorization request may be denied if:
- Medicare finds you don’t medically require a power wheelchair
- Medicare doesn’t get enough information to make a decision
If Medicare needs additional information, your DME supplier may resubmit your prior authorization request.
