As more and more people enter Medicare every year, millions of Americans are experiencing the cost savings for health care provide by this program. Americans save money with Medicare in two ways: costs for coverage (premiums) and costs for services (co-payments or co-insurance). These costs are particularly attractive for medical services and procedures. However, the story is a little different for Medicare-covered medical equipment. These products make like easier for those who need them, but they can be expensive, even under Medicare. In this article, we’ll examine Medicare coverage for wheelchairs and scooters, focusing on their costs under Medicare and some ways to limit your spending on these devices.
Original Medicare For Wheelchairs And Scooters
The most basic aspect of Medicare coverage is Original Medicare, the government-sponsored health insurance program split into Parts A and B. Part B of Original Medicare covers Durable Medical Equipment (DME). Medicare defines DME as medical equipment that’s ordered by a doctor for use in your home, or at least out of a medical setting. A key component relating to Medicare coverage of this equipment is that it must be medically necessary (this is actually a key to anything covered by Medicare). So, this equipment can’t just make like easier or more convenient. It must be used for a diagnosed medical purpose, which is why this equipment must be prescribed by a doctor.
There are myriad kinds of Durable Medical Equipment, but some common kinds include:
- Diabetes monitoring supplies
- Oxygen equipment and accessories
- Canes and walkers
- Wheelchairs and scooters
- Hospital beds
- Many others
As you can see, several kinds of mobility aids qualify as Medicare-covered Durable Medical Equipment. And, given the nature of their use, they’re designed to be used not only at home, but out and about; basically anything other than in a medical facility.
Medicare will only cover Durable Medical Equipment if it is ordered and supplied by providers who participate in Medicare. If you use a non-Medicare supplier, you’ll have to pay the full cost, even if the piece of equipment is normally covered by Medicare.
Medicare Approval Of Wheelchairs And Scooters
There is a specific procedure that needs to be followed to qualify for Medicare coverage of these mobility aids. In order to have Medicare cover certain kinds of power wheelchairs or scooters, you need to obtain prior authorization. This means that once your provider (usually a doctor) prescribes a wheelchair or scooter, the DME supplier will submit a pre-authorization request to Medicare directly. You won’t need to do anything. If Medicare has questions or needs more information, they will work directly with the supplier.
How Much Do Wheelchairs And Scooters Cost Under Medicare Part B?
Since Medicare coverage for Wheelchairs and scooters falls under Part B, there are a couple of costs you can face. These include:
- Part B deductible
- Part B co-insurance
- Part B excess charges
The Part B deductible must be met before Medicare will provide any coverage. The Part B deductible is quite small. For 2020 it was $203 and for 2022 it will be $233. Once you’ve paid this amount in Part B expenses, Medicare will begin paying 80% of the cost for Part B services and procedures, including Durable Medical Equipment. You will pay the remaining 20%. In addition to this, you could encounter Part B “excess charges” when you need DME. Excess charges are charged by providers who do not accept Medicare “assignment.” Medicare assignment is a set list of prices that Medicare reimburses to providers. Most providers do accept these prices, but if they don’t, they’re allowed to charge up to 15% of the Medicare-approved amount in addition to the approved-amount. You are responsible for this cost.
Private Medicare Coverage For Wheelchairs And Scooters
Because of the out of pocket costs associated with Original Medicare, many people choose to use a private Medicare plan to help lower or cap their health care spending. The two most popular options are Medicare Supplement Insurance and Medicare Advantage plans. Both of these kinds of plans will cover Durable Medical Equipment like wheelchairs and scooters. We’ll examine each of these coverages in turn.
Medicare Advantage And Wheelchairs And Scooters
Generally speaking, Medicare Advantage plans cover Durable Medical Equipment at the same rate as Original Medicare. This means that you’ll be expected to pay 20% of the cost, just like under Part B. This is one of the few areas that Medicare Advantage plans charge co-insurance for, rather than fixed co-payments. Some plans will provide coverage of certain DME, like diabetes supplies, for a fixed co-payment, but this is not standard. On the plus side, Medicare Advantage plans do come with an Out of Pocket Maximum (OOPM) limitation, so your DME costs would also be capped if you hit this limit during a year.
Medicare Supplement Insurance And Wheelchairs And Scooters
Medicare coverage for wheelchairs and scooters is much more comprehensive with Medicare Supplement Insurance. Supplement, also known as Medigap, coverage works with Original Medicare, and generally pays most or all of what Original Medicare doesn’t. In other words, when you have Medicare Supplement, it is your secondary insurance; Original Medicare is your primary.
There are ten standardized Medigap plans (the coverage is exactly the same from one insurance company to another). In eight of these Medicare Supplement plans, the plan will pay 100% of your Part B out-of-pocket costs. The other two provide partial coverage:
- Plan K pays 50% of your costs
- Plan L pays 75% of your costs
It’s important to know that most people will still have to pay the Part B deductible before their Medicare Supplement plan will help pay for their Durable Medicare Equipment.
As an example of how this works, let’s consider the need for a scooter. Once you receive prior authorization from Medicare, they will pay 80% of the approved amount, assuming that you’ve already met the Part B deductible for the year. This leaves 20% for you to pay. However, since you have Medicare Supplement Insurance, you’ll pay $0, unless you have Plan K or L, in which case you’d only pay 50% or 25% of what you’d pay under Original Medicare.
Durable Medical Equipment like wheelchairs and scooters can make a huge difference in your qualify of life. Being able to afford these items is an important aspect of your Medicare coverage. If you need help picking a plan that makes DME affordable to you, reach out to us today. Our licensed insurance agents can help you find and compare quotes from multiple plans available in your area. Schedule a free, no-obligation consultation today.