Medicare is health insurance coverage for those persons who are either 65 years of age or older, who are blind, totally and permanently disabled, and have been receiving Social Security disability payments for 24 months, or who have end-stage renal disease. Many Medicare recipients are also eligible for Medicaid benefits. In those cases Medicaid will pay the Part B insurance premiums plus the co-insurance and deductible amounts and other charges sponsored by Medicaid, but not covered by Medicare.
You can apply for Medicare at the local offices of the Social Security Administration.
Power Wheelchair Reimbursement
Most power wheelchairs are recognized and qualify for potential reimbursement under Medicare and other Health Care Insurance Companies.
If you need a power chair for mobility and you meet your insurance’s coverage guidelines, they may pay for all or part of the cost of the power chair. Coverage criteria and payment amounts will vary depending on the type of insurance you have. Most health care insurance companies, including Medicare, have minimum requirements that need to be met before they will purchase a power chair for you.
Motorized / Power Wheelchair
Medicare Coverage Criteria
A power wheelchair is covered when all of the following criteria are met:
The patient’s condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined; and,
The patient must require the need of their power wheelchair to perform Mobility Related Activities for Daily Living (MRADLS) such as feeding, grooming, dressing, bathing, and light housekeeping; and,
The patient is capable of safely operating the controls for the power wheelchair.
The patient must be evaluated with a face-to-face exam by their physician. Some criteria that must be included are: pertinent diagnosis/conditions, upper and lower extremity strength or lack thereof, has the patient tried a least costly alternative? Also required are physical or occupational therapy notes and past medical history which is related to mobility issues.
A patient who requires a power wheelchair usually is totally nonambulatory and has severe weakness of the upper extremities due to a neurologic or muscular disease/condition. If the documentation does not support the medical necessity of a power wheelchair the power wheelchair will be denied as not medically necessary. Options that are beneficial primarily in allowing the patient to perform leisure or recreational activities are noncovered. A power wheelchair is covered if the patient’s condition is such that the requirement for a power wheelchair is long term (at least six months). Payment is made for only one wheelchair at a time. Backup chairs are denied as not medically necessary. Reimbursement for the power wheelchair includes all labor charges involved in the assembly of the wheelchair and all covered additions or modification.
Reimbursement also includes support services, such as emergency services, delivery, set-up, education, and on-going assistance with use of the wheelchair.
If you feel you meet these requirements, you may be eligible to receive the most stylish, best performing and most reliable power chair available on the market today.