Does Medicare Pay for Power Wheelchairs? | Franklin TN

Your Guide to Power Wheelchair Medicare Coverage

Have you experienced a greater lack of mobility due to an injury or illness? Does it limit your ability to independently access your own home in , ? You may be considering a power wheelchair but wonder about the cost and if your Medicare will help cover it. Medicare does cover power wheelchairs under certain conditions. To qualify, you must meet specific criteria:

1. Use Within Home: You must have a need to use the power wheelchair within your home to demonstrate medical necessity.
2. Significant Mobility Issues: You must have a health condition that causes significant difficulty moving around in your home.
3. Inability to Perform Daily Activities: You must be unable to perform daily living activities such as bathing, dressing, getting in or out of bed or a chair, or using the bathroom, even with the aid of a cane, crutch, or walker.
4. Safe Operation: You must be able to operate and get on and off the wheelchair safely or have someone always available to help you use the device safely.
5. Medicare Acceptance: Both the doctor treating your condition and the wheelchair supplier must accept Medicare.
6. Home Suitability: Your doctor or supplier must visit your home to verify that you can use the wheelchair within your home, ensuring it fits through doorways and is not obstructed by floor surfaces or other barriers.

Documentation and Ordering Process

To begin the process, your doctor must submit a written order to Medicare, known as a Certificate of Necessity. This document must:

• State that you have a medical need for a wheelchair in your home.
• Provide evidence that a cane, walker, or manual wheelchair is insufficient for your daily activities.
• Include comprehensive documentation of your condition and the necessity for an power wheelchair.

The Certificate of Necessity is a critical part of the approval process, detailing why less advanced mobility aids, such as a cane, walker, or manual wheelchair, won’t suffice for your daily activities. Your doctor must thoroughly document your condition and explain why an power wheelchair is necessary for you to maintain your independence and quality of life.

Limitations on Coverage

Medicare restricts coverage of power wheelchairs to use strictly within the home environment. If your primary need for a wheelchair is outdoor mobility, Medicare will not cover the cost. Additionally, Medicare’s coverage is limited to specific wheelchair models that are not folding, lightweight, or designed to break down into parts. These criteria ensure that the wheelchair is suitable for navigating within your home, including fitting through doorways and maneuvering around furniture.

Medicare does not extend coverage to wheelchairs intended for outdoor use or models designed for easy transportation, such as folding or lightweight options. It’s important to consider these restrictions when evaluating your options for an power wheelchair under Medicare, as they impact the eligibility and choice of models available for coverage.

The Approval Process

The process to secure Medicare approval for an power wheelchair is comprehensive and typically takes 60 to 90 days. During this period, it is crucial to complete and meticulously review all necessary documentation and evaluations.

Once your doctor submits the Certificate of Necessity, Medicare embarks on a thorough review to assess whether you meet the stringent eligibility criteria. This critical evaluation phase can extend up to three months, underscoring the importance of strategic planning and attention to detail.

Ensuring that all documentation is accurate, comprehensive, and in line with Medicare’s requirements is essential to avoiding potential delays and ensuring a smooth approval process for your power wheelchair.

Personalized Service and Support

While we do not work directly with insurance companies, at All-Star Medical we are committed to helping you understand the Medicare approval process for power wheelchairs and other medical equipment. Our team provides expert guidance on various wheelchair models, ensuring you find the optimal solution tailored to your specific needs. If Medicare doesn’t cover the model you require, we offer flexible financing options to facilitate your purchase.

We pride ourselves on delivering personalized service taking the time to understand your unique requirements and preferences. Whether clarifying Medicare requirements, demonstrating wheelchair functionalities, or discussing payment options, our dedicated staff is here to support you every step of the way. Our goal is to ensure you receive the best possible mobility solution that enhances your independence and quality of life, regardless of Medicare coverage limitations.

Quality Products

We offer a wide range of quality products, ensuring you find the right mobility solution. Explore our offerings:

• Lift chairs: With options like, heat, massage and zero gravity positions, lift chairs can provide safety and comfort with numerous other benefits.
• Mobility scooters: A mobility scooter will help you to reclaim your independence at home or on the go. We stock models with 3 or 4 wheels as well as a large selection of convenient folding models for easy transport.
• Rollators and Walkers: Depending on your need, we have models for all levels of support and convenience. 3 or 4-wheeled rollators as well as walkers and accessories, we have what you need to support independent mobility.
• And much more! Whether you need a stair lift for safe floor access, a hospital bed for recovery, or anything in between, we’ve got you covered. Our wide range of mobility and healthcare products includes bathroom safety equipment, wheelchair ramps, personal care items, and even medical equipment rentals. We are your one-stop shop for enhancing your independence and comfort at home.

All-Star Medical for All Your Needs

Understanding whether Medicare covers power wheelchairs can be complex, but All-Star Medical is here to help. With our personalized service, quality products, and knowledgeable staff, we ensure you find the best mobility solutions to meet your needs. Visit our locations in Brentwood and Hermitage, or contact us with any questions. We are committed to helping you achieve greater independence and mobility with the right equipment tailored to your needs.