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Overview

Medicare is a federally funded health insurance program, designed to provide health insurance to people age 65 and over and certain people with disabilities. The Health Care Financing Administration (HCFA) runs the Medicare program, and the Social Security Administration helps by enrolling qualified participants into the program.

Medicare has two parts. Part B is the medical insurance part of Medicare that pays for Durable Medical Equipment (DME).

Eligibility Requirements

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-sage 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.

Application Process

You can apply for Medicare at the local offices of the Social Security Administration.

Power Wheelchair Chair 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.

Medicare Coverage Criteria

A power wheelchair is covered if: The patient has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADL) such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home; The patient's mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker; the patient does not have sufficient upper extremity function to self-propel an optimally-configured manual wheelchair in the home to perform MRADL during a typical day; the patient's home does provide adequate access between rooms, maneuvering space and surfaces for the operation of the power wheelchair that is provided; use of a power wheelchair will significantly improve the patient's ability to participate in MRADL and the patient will use it on a regular basis in the home; the patient has not expressed an unwillingness to use the power wheelchair that is provided in the home; the patient does not have sufficient strength, postural stability, or other physical or mental capabilities needed to safely operate a POV/scooter in the home, or The patient's home does not provide adequate access between rooms, maneuvering space, and surfaces for the operation of a POV/scooter with a small turning radius; and the patient has the mental and physical capabilities to safely operate the power wheelchair that is provided, or the patient has a caregiver who is unable to adequately propel an optimally configured manual wheelchair, but is available, willing, and able to safely operate the power wheelchair that is provided.

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 at little or no money out of pocket.

Common Questions Regarding Medicare Reimbursement

Will Medicare pay for a power wheelchair?

If you qualify, Medicare will pay for a portion of your power wheelchair.

If I qualify, how much will Medicare pay toward the purchase of a power wheelchair?

Medicare will pay 80% of a set allowable for a power wheelchair. The amount depends on the type of power wheelchair you choose and on your state of residence. On average the amount reimbursed by Medicare is around $4,000.00.

How do I know if I qualify?

See "Medicare Coverage Criteria" above.

How do I submit a claim to Medicare? What other information needs to be sent?

Once a completed prescription order and other applicable information are obtained from your treating physician we will submit a claim to Medicare on your behalf. Medicare will process your claim and inform you of their payment decision in about 30-45 days.

Can I find out if I medically qualify before I purchase the power wheelchair?

At this time, Medicare offers Advance Determination of Medicare Coverage (prior authorization) for certain types of power wheelchairs. The power wheelchairs eligible for this are those that come with a power tilt or power recline seating system or those that come with some type of specialty control device. If your physician prescribes a power wheelchair with one of these options, we can send a request to Medicare to see if you qualify in advance. Medicare will let you know within 30 days if you medically qualify.

Power Operated Vehicles (POVs)/Scooters

Motorized Scooter Reimbursement

Most scooters or power operated vehicles (POVs) are recognized and qualify for potential reimbursement under Medicare and other health care insurance companies as a power operated vehicle or (POV).

If you need a scooter for mobility and you meet your insurance's coverage guidelines, they may pay for all or part of the cost of the scooter. 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 scooter for you.

Medicare Coverage Criteria

A power operated vehicle (POV)/scooter coverage is similar to that for a power wheelchair, except that the patient does have sufficient strength, postural stability, or other physical or mental capabilities needed to safely operate a POV/scooter in the home; and the patient's home does provide adequate access between rooms, maneuvering space and surfaces, for the operation of a POV/scooter with a small turning radius; the patient is unable to operate a manual wheelchair; the patient is capable of safely operating the controls of the POV; The patient can transfer safely in and out of the POV and has adequate trunk stability to be able to safely ride in the POV, and It is ordered by a treating physician.

Seat Lift Chair Reimbursement

Most seat lift chairs are recognized and qualify for potential reimbursement under Medicare and other health care insurance companies.

If you need a lift chair and you meet your insurance's coverage guidelines, they may pay for all or part of the cost of the lift 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 lift chair for you.

Seat Lift Chairs Medicare Coverage Criteria

A seat lift mechanism is covered if all of the following criteria are met:

1. The patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease.
2. The seat lift mechanism must be part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition.
3. The patient must be completely incapable of standing up from a regular armchair on any chair in their home. (The fact that a patient has difficulty or is even incapable of getting up from a chair, particularly a low chair, is not sufficient justification for a seat lift mechanism.)
4. Almost all patients who are cable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.
5. Once standing, the patient must have the ability to ambulate.
6. Coverage of seat lift mechanisms is limited to those types which operate smoothly, can be controlled by the patient, and effectively assist a patient in standing up and sitting down without other assistance. Excluded from coverage is the type of lift which operated by spring release mechanism with a sudden, catapult-like motion and jolts the patient from a seated to a standing position. Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair.

If you feel you meet these requirements, you may be eligible to receive the most stylish, best performing and most reliable lift chair available on the market today.

If you have any questions call the Medicare office at 1-800-MEDICARE.