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Insurance Billing for Manual Wheelchairs, Power Wheelchairs, and Powered Scooters

To keep prices low, EnableYourLife.com does not bill Medicare or Private insurance for items that may be covered under your plan. We provide the following information as a courtesy only, and it may not constitute all of the information applicable to your specific insurance plan.

Medicare Insurance

If you are covered under a Medicare Group B plan, Medicare may provide coverage of these items on a “capped rental basis”. That is to say that the item can be rented for 13 months and require a monthly co-pay of 20% of the rental amount (Medicare will pay 80% of the Medicare approved amount). After 13 months of continuous rental, the item is considered “purchased”. If you have a secondary insurance plan, it may cover the 20% the beneficiary is responsible for.

Since EnableYourLife.com only sells new equipment and does not provide rentals, our low price to purchase the item may be cheaper than the 13 monthly co-pays required under the Medicare-approved amount.

Private Insurance

If you have a private insurance company, you may be able to submit a claim for an item purchased from EnableYourLife.com. You will need to contact your insurance company first to see if you are covered. Be sure to state exactly what you wish to purchase and ask what the requirements are. Please give us a call at 1-800-983-3602 if your insurance company is requesting any information from us.

(Below are Medicare’s guidelines for wheelchair and scooter benefits. The information is taken directly from Medicare form CMS Product No. 11046, Revised January 2011. This information is provided as a courtesy and is subject to change at any time.)

Medicare’s Wheelchair and Scooter Benefit

If your doctor submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home, Medicare will help cover any of the types listed below. Generally, Medicare will pay 80% of the Medicare-approved amount, after you have met the Part B deductible. You pay 20% of the Medicare-approved amount.

Wheelchairs (both manual and power) and scooters are also known as “mobility assistive equipment.” Medicare will help cover your wheelchair and scooter, if you meet all of the following conditions:
  • You have a health condition that causes difficulty moving around in your home.
  • You’re unable to do activities of daily living (like bathing, dressing, getting in or out of a bed or chair, or using the bathroom) even with the help of a cane, crutch, or walker.
  • You’re able to safely operate, and get on and off the wheelchair or scooter, or have someone with you who is always available to help you safely use the device.

Also, the equipment must be usable within your home (for example, it’s not too big for your home or blocked by things in its path).

Types of Mobility Assistive Equipment:

Manual Wheelchair

If you can’t use a cane or walker safely, you may qualify for a manual wheelchair. The manual wheelchair you choose can’t be a high strength, ultra-lightweight wheelchair that you could buy without renting first.

Rolling Chair/Geri-chair

If you need more support than a wheelchair can give, you may qualify for a rolling chair. These chairs have small wheels that are at least 5 inches in diameter. The rolling chair must be designed to meet your medical needs due to illness or other impairment.

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.

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.

Before you get either a power wheelchair or scooter, you must have a face-to-face exam by your doctor. The doctor will review your needs and help you decide if you can safely operate the device. If so, the doctor will submit a written order telling Medicare why you need the device and that you’re able to operate it.

Remember, you must have a medical need for Medicare to cover a power wheelchair or scooter. Medicare won’t cover this equipment if it will be used mainly for leisure or recreational activities, or if it’s only needed to move around outside your home.

Also, in some areas, you may need to get your power wheelchair or scooter from specific suppliers approved by Medicare. Visit www.medicare.gov/supplier or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call1-877-486-2048.

Note: If you don’t need a power wheelchair or scooter on a long-term basis, you may want to rent the equipment to lower your costs. Talk to your supplier to find out more about this option. Some wheelchairs must be rented first, even if you eventually plan to buy them.

Fraud

Most doctors, health care providers, suppliers, and private companies who work with Medicare are honest. However, there are a few who aren’t. For example, some suppliers of medical equipment try to cheat Medicare by offering expensive power wheelchairs and scooters to people who don’t qualify for these items. Also, some suppliers of medical equipment may call you without your permission, even though “cold calling” isn’t allowed. Medicare is trying harder than ever to find and prevent fraud and abuse by working more closely with health care providers, strengthening oversight, and reviewing claims data.

How to Spot Fraud and Abuse

You can help Medicare stop fraud and abuse by watching for the following examples of possible Medicare fraud:
  • Suppliers offer you a free wheelchair or scooter.
  • Suppliers offer to waive your copayment.
  • Someone bills Medicare for equipment you never got.
  • Someone bills Medicare for home medical equipment after it has been returned.

What to Do if You Suspect Fraud and Abuse

If you suspect billing fraud, contact your health care provider to be sure the bill is correct. If your doctor, health care provider, or supplier doesn’t help you with your questions or concerns or if you can’t contact them, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

For More Information

Medicare is here for you 24 hours a day, every day. To get more information, visit http://www.medicare.gov/or call 1-800-MEDICARE. For more information about Medicare’s fraud and abuse activities, visit How to report Medicare fraud.