Medicare and Insurance
Will My Insurance Pay for my Power Wheelchair or Electric Scooter?
Pro Wheelchairs hears this question a lot and we understand why.... because these items are expensive. We do not have the answer to every situation but we can provide you with some things we do know about getting insurance to cover your wheelchair or scooter costs.
There are 3 main medical insurance coverages: Private Insurance either HMO or PPO, Medicare, and Medicaid
First of all, we suggest you contact your insurance company directly to get the details of your coverage. The types of equipment your health plan will pay for and how much you will be required to pay (your co-payment) can vary based on your plan coverage. Most health plans follow similar guidelines as Medicare when it comes to power wheelchair and scooter coverage. These are the types of equipment your health plan may pay for:
1. Manual wheelchair - If you can’t use a cane or walker safely, but you have enough upper body strength or have a caregiver who’s available to help, you may qualify for a manual wheelchair.
2. Power-operated vehicle/scooter - If you can’t use a cane or walker, or can’t operate a manual wheelchair, you may qualify for a power-operated scooter, if you can safely get in and out of it and are strong enough to sit up and safely operate the controls.
3. Power wheelchair - If you can’t use a manual wheelchair in your home, or if you don’t qualify for a power-operated scooter because you aren’t strong enough to sit up or to work the scooter controls safely, you may qualify for a power wheelchair.
What is the Process for Coverage?
Start by calling your insurance company's customer services department so they can explain the steps required to get your equipment covered under the plan. Medicare.gov says that all people who meet criteria with Medicare Part B are covered for scooters (which they define as “manual wheelchairs & power mobility devices”). Most likely the steps will include:
1. Face to Face Exam with a doctor or physical or occupational therapist, which will include a physical exam and a functional assessment to determine your need for the mobility device. If you need a power wheelchair or scooter your doctor must prove why. The scrutiny surrounding a popular scooter store that did a tremendous amount of TV advertising has led to tighter restrictions on Medicare-covered scooters, making eligibility for these scooters a difficult issue to make your way through. Once your doctor or specialist determines your need they will write you a prescription.
2. Use a Medicare Approved Supplier to help you choose the equipment your doctor prescribed. Your best chance for coverage under your plan is to take your prescription to a wheelchair/scooter (Durable Medical Equipment-DME) supplier in your healthcare network. The insurance may not cover your equipment if you do not use one of their in-network suppliers. If your supplier accepts Medicare for payment you pay 20% of the Medicare-approved amount and the Part B deductible applies. Click here to find a Medicare Approved DME Supplier.
Other things to keep in mind:
1. Wheelchairs are approved once every 5 years - Private Insurance and government programs will only pay for mobility equipment once every 5 years.
2. Once you get your wheelchair or scooter it cannot be returned - once you get your equipment in most cases it can't be returned so it's important to pick the right equipment. However, you do have rights if the equipment is defective and you can follow up with the supplier if that's the case.
How can Pro Wheelchairs Help?
Medicare is making it more difficult for people who want help with purchasing a scooter today. We assist people in our communities every day in getting the right wheelchairs and scooters for their needs. We hear many stories from our loyal customers about Medicare reimbursement for scooters and they are saying how much work it is to try to get coverage and in the end, they get denied. We have asked many of our suppliers about helping our customers with insurance claims and they tell us: “Medicare rarely pays for senior scooters. We submit claims all the time and they always deny them. You will end up paying out of pocket for a senior scooter.”
Pro Wheelchairs has a wide variety of wheelchairs, power wheelchairs and scooters at many price points to meet your needs. We accept all major credit cards and we offer payments over time to help make paying out of pocket for these items a little easier. We offer FREE shipping and your items will be delivered right to your door.