As you age, your needs for medical assistance increase. Most individuals over the age of 65 in the United States qualify for Medicare or Medicaid and receive insurance benefits through this source. As with any insurance company there are rules to follow in order to make sure that you receive coverage for certain services. Medicare covers wheelchairs or durable medical equipment. Here is a guide to follow to make sure you get coverage:
For any wheelchair to be approved by Medicare, a patient first must have approval from their physician that there is a need. Be sure to communicate the problems with activities of daily living that you are having so that your doctor knows that your mobility issue are a true problem. Understand that the equipment must be a necessity for you to use inside your home. If you are in a nursing home or other facility this cannot qualify as your home.
Also, you must have a face-to-face visit with your doctor in order to get your wheelchair approved. Your doctor must sign a prescription or certification document that states that your health limits you from getting around with just the use of a cane or walker. The doctor must also state that you are having problems with activities of daily living and that your required office visit occurred. This certificate of medical necessity is an essential step in the process. You must also make sure that you have someone who can help you use the wheelchair.
Medicare engages in a competitive bidding process, but only approves certain providers for patients to get durable medical equipment from. A list of approved providers of durable medical equipment is then produced. Make sure that you use one of these approved providers when you purchase your durable medical equipment.
Medicare will not cover this type of equipment if it is not purchased through an approved provider. Once you choose a supplier, the company must send a representative to thoroughly assess your home in order to provide an evaluation your home for a wheelchair that is appropriate for use. This must occur in order to get approved equipment.
Typically, Medicare requires that the patient pay 20 percent of the cost of the wheelchair. Medicare supplemental policies may cover this amount so be sure to check your policy prior to obtaining your certificate of medical necessity. Also, sometimes Medicaid will cover the 20 percent deductible if patients meet eligibility requirements. In addition, if you cannot cover the complete cost of a purchased item, you may be able to rent the equipment and Medicare or Medicaid will pay for the rental.
Medicare in general will cover durable medical equipment if the certification process is properly complete. Although the deductible may need to be met by the patient, supplemental Medicare insurance may cover this additional deductible cost. Make sure you know which plans you have prior to obtaining certification of medical necessity. This will help ensure that your claim is paid.
Medicare Advantage plans operate a little differently than traditional Medicare plans. These plans are required to cover the same types of services as traditional Medicare, but may differ in how they deliver these services. Medicare Advantage does cover durable medical equipment, but you need to contact your individual plan to check what level of coverage you have and what process needs to be followed to activate coverage. Knowing the process ahead of certification of need will help you meet the procedural requirements so that the durable medical equipment costs are covered.
Obtaining the financial coverage you need for your wheelchair can be a complex process. Following these steps and asking questions to the appropriate parties along the way will help guide you in the appropriate direction. Medicare covers a variety of durable medical equipment needs if you follow the right steps. The Medicare website has more information about coverage and can help to answer any additional questions about your eligibility. If you have additional questions your doctor may be a good resource for help as well.