One of the first questions many folks ask when they are facing mobility issues is how they will pay for the mobility equipment they need. For most, Medicare is the first place they look for coverage. However, when it comes to Medicare benefits, questions abound. In this article, we will cover the ins and outs of Medicare coverage for wheelchairs and scooters, explain the process, and answer some of the more common question questions regarding this benefit.
Medicare classifies wheelchairs and scooters, as well as many other mobility products, as Durable Medical Equipment (DME). There is a Medicare benefit covering DME, but there are some conditions and limitations. Generally speaking, as long as these conditions are met, Medicare will pay for 80 percent of the cost of the equipment. Private insurance may help cover some or all of the remaining balance.
The first step in getting your DME covered is visiting your doctor. Your doctor must be enrolled in the Medicare program. He or she will examine you and determine what kind of medical equipment your condition requires. At this point, they will then prescribe the equipment for your use. Getting this prescription is important for receiving your DME Medicare benefit. While some medical equipment is available for private purchase without a prescription, most requires one, and regardless, to receive Medicare coverage, a doctor must prescribe the equipment for your in-home use.
Once you have the prescription, it’s time to find a dealer. This dealer must be enrolled in Medicare in order for you to receive coverage for the DME. Your dealer isn’t required to accept assignment, but if they do not, you may be required to pay the entire bill (both your share and Medicare’s) at the time of purchase, and then file for reimbursement.
It’s important to note that Medicare does not limit what suppliers are allowed to charge you, but they do limit their benefit. They will only cover 80 percent of the Medicare-approved amount, leaving you to cover any remainder. The San Diego area, including Carlsbad and San Marcos, is in a Medicare competitive bidding area, which further limits the amount Medicare will pay towards your DME.
For these reasons, it’s important to buy from a reputable dealer who understands the DME benefit and the intricacies of Medicare’s requirements, and who will take the time to sit down with you and clearly explain their price and your share. Your dealer should also be able to work with your private insurance, if you have any, and make sure you are also receiving the maximum benefit from that insurance. When Medicare and private insurance benefits are combined properly, you may end up having to pay little or nothing out of pocket.
Here at Pacific Mobility Center, we have a wide range of scooters and powerchairs to fit your needs, but more importantly than that, because we have been in business for over 20 years, we have the knowledge and skills to help navigate the Medicare and insurance process. We will help you determine what your coverage is, and clearly explain your benefits, as well as your out-of-pocket costs. We help with the paperwork, and do what it takes to make purchasing your new powerchair or scooter a breeze. We also guarantee the lowest prices in the San Diego area, so you can be sure you’re getting a great deal. Because we also live locally, we care about our clients and do everything in our power to make sure the buying process is easy, fair, transparent, and satisfying. Come see what a difference family ownership, experience, and a local connection to the community makes. Contact us or come on in to our beautiful showroom today!
President, Husband, Father, Grandfather Graduate of UC Davis- Bio Sci Major- Go Aggies! Jeff has extensive experience in all of Pacific Mobility’s products and services, and specializes in accessibility products as well as stairlifts, ceiling lifts and custom wheel chairs. His hobbies include spending time with family, gardening, mountain biking, exercising and off road motorcycle riding.
24 years as Owner/President of Pacific Mobility Center – selling, installing, and servicing stairlifts, porch lifts, ceiling lifts, pool lifts, handicap ramping, specialty wheelchairs, scooters, power wheel chairs, and other power mobility devices
Certified Environmental Access Consultant since 2008
Licensed General Contractor since 1998
Certified Aging in Place Specialist since 2016
Board Member for Home Access Professionals
Member of Association of Members of the Accessibility Equipment Industry (AEMA)