One of the most common questions we are asked by our
customers is if Medicare or Private Insurance will cover the cost of an electric
wheelchair or scooter.
If
you have Medicare insurance and /or private insurance and you qualify
through your doctor, you may be able to receive a power wheelchair for
little or no money out of pocket !!!!! We will handle all of the paperwork
for you and let you know as soon as we have approval from your doctor! Sorry,
we do not deal with any HMO insurances. For
more coverage details, please look below
or
to see if you qualify, click HERE.
or call 1-800-449-8991
Criteria for
Electric Wheelchairs
We do accept assignment on electric wheelchairs.
This means that if you qualify, we will deliver the power chair to you, and
bill Medicare or your private insurance company for payment. Sorry,
we do not handle any HMO insurances. To see if you qualify for a power wheelchair, your
doctor must complete a form called a Certificate of Medical necessity (CMN).
We must also collect a prescription from your doctor as well as a medical evaluation
by your doctor or physical therapist. The way that your doctor answers the questions on the
CMN will determine if
the power wheelchair is a medical necessity. Listed
below is what Medicare states as the medical criteria that must be met in
order to qualify:
An electric wheelchair is usually covered when all of the following criteria are
met:
-
The patient's condition is such that without the use of a wheelchair the patient would
be bed or chair confined, and
-
The patient's condition is such that a wheelchair is medically necessary and the patient
is unable to operate a wheelchair manually, and
-
The patient is capable of safely operating the controls for the
scooter or power wheelchair.
Criteria for
Scooters
If you purchase a scooter from us, Medicare and
Private insurance may reimburse you if you meet there coverage criteria. We do not
accept assignment on scooters. This means that you must purchase the
scooter first, then we will contact your doctor for you and request the
paperwork needed in order to file a claim with your insurance company for
reimbursement to you. We do not guarantee reimbursement from Medicare or
any Private Insurance companies. We will file the claim for you with Medicare, or
private insurances that are a PPO, if you qualify through your
doctor.
Sorry, we do
not bill any HMO insurances for reimbursement.
In order to file a claim with Medicare for a scooter, we must get a
prescription for an electric scooter, a Certificate of Medical Necessity ( CMN )
and a current medical evaluation. The Certificate of Medical Necessity (CMN),
and all other paperwork is used by Medicare to determine
if the scooter is a
medical necessity.
An electric scooter is usually covered when all of the following
criteria is met:
-
A POV (electric scooter) is usually covered only if it is ordered by a physician who is
in one of the following specialties: Physical Medicine, Orthopedic Surgery, Neurology or
Rheumatology
-
The patient must be unable to operate a manual wheelchair.
-
The patients condition must be such that a POV is required for the patient to get around
in his or her residence. A POV that is beneficial only in allowing the patient to perform
leisure or recreational activities will be denied as not medically
necessary.
Criteria for
Lift Chairs
Unfortunately, Medicare will
not pay the entire cost of a lift chair, however, they will reimburse on the
lift motor, if you qualify. You must first purchase the Lift Chair, then
all of
the necessary paperwork will be gathered for you and your claim will be
filed for reimbursement. Any payment from
Medicare will be sent to you by Medicare.
In order to file a claim with Medicare for a lift chair, a Certificate
of Medical Necessity ( CMN ) is required to be filled out by your doctor and filed with
your claim. All of the necessary paperwork will be gathered for you and the
claim will be filed for you. In
some states it is also necessary to get a letter explaining the medical necessity of the
item from your doctor. The CMN is used by Medicare to determine if the Lift Chair is
a
medical necessity.
A Lift Chair is usually covered when all of the following
criteria is met:
The patient must have severe arthritis of the hip or knee, or have a
neuromuscular condition.
The seat lift mechanism must be part of the physicians course of
treatment and be prescribed to effect improvement, or arrest or retard deterioration
in the
patients condition.
The patient must be completely incapable of standing up from a regular
armchair or any chair in their home.
Once standing, the patient must have the ability to ambulate.
Medicare Allowable
Listed below is the current Medicare allowable by state for
electric wheelchairs, scooters and lift chairs. If Medicare is your primary
insurance and if you qualify though your doctor, Medicare may pay 80 % of
the amount listed below for your mobility equipment.
STATE |
SCOOTERS |
POWER CHAIRS |
LIFT CHAIRS |
AK |
1752.45 |
5799.30 |
318.59 |
AL |
2032.94 |
4947.00 |
321.75 |
AR |
2157.36 |
5052.00 |
314.98 |
AZ |
2157.36 |
4688.80 |
315.44 |
CA |
1833.76 |
4813.00 |
315.44 |
CO |
1833.76 |
5052.00 |
321.75 |
CT |
2157.36 |
5052.00 |
321.75 |
DC |
1941.10 |
5052.00 |
315.44 |
DE |
1941.10 |
4931.30 |
315.44 |
FL |
1833.76 |
4624.60 |
321.75 |
GA |
2157.36 |
4900.30 |
321.75 |
HI |
1873.90 |
5134.80 |
340.66 |
I A |
2157.36 |
5052.00 |
314.99 |
ID |
1833.76 |
5052.00 |
321.75 |
IL |
1887.62 |
5052.00 |
321.75 |
IN |
2020.16 |
5052.00 |
303.75 |
KS |
2157.36 |
5052.00 |
317.54 |
KY |
2157.36 |
5052.00 |
321.75 |
LA |
1915.58 |
4962.90 |
314.98 |
MA |
2157.36 |
5052.00 |
321.75 |
MD |
1900.39 |
4765.60 |
315.44 |
ME |
2157.36 |
5052.00 |
321.75 |
MI |
1833.76 |
4831.60 |
315.44 |
MN |
2157.36 |
5052.00 |
321.75 |
MO |
2157.36 |
5052.00 |
321.75 |
MS |
1833.76 |
4527.10 |
315.44 |
MT |
1833.76 |
4555.40 |
321.75 |
NC |
1833.76 |
5052.00 |
321.75 |
ND |
2157.36 |
4549.00 |
321.75 |
NE |
2157.36 |
5052.00 |
314.98 |
NH |
2157.36 |
5052.00 |
321.75 |
NJ |
1941.10 |
4740.70 |
315.44 |
NM |
2121.88 |
4466.00 |
315.44 |
NV |
2157.3 |
4802.30 |
315.44 |
NY |
2157.36 |
4898.90 |
313.82 |
OH |
2112.84 |
5052.00 |
315.44 |
OK |
2157.36 |
5052.00 |
315.44 |
OR |
2157.36 |
5052.00 |
321.75 |
PA |
1941.10 |
4841.60 |
315.44 |
PR |
2563.78 |
5924.90 |
378.51 |
RI |
2157.36 |
4294.20 |
321.75 |
SC |
1833.76 |
4865.00 |
321.75 |
SD |
2157.36 |
4954.50 |
321.75 |
TN |
1922.21 |
4736.10 |
321.75 |
TX |
1991.61 |
5052.00 |
315.45 |
UT |
2157.36 |
5052.00 |
321.75 |
VA |
1976.47 |
4769.70 |
321.75 |
VI |
2157.36 |
5052.00 |
313.82 |
VT |
2157.36 |
5052.00 |
321.75 |
WA |
2157.36 |
5052.00 |
315.44 |
WI |
2157.36 |
5052.00 |
315.44 |
WV |
2138.46 |
4881.10 |
315.44 |
WY |
2157.36 |
4938.90 |
321.75 |
At this time, the cost of a manual wheelchair or a vehicle lift is not
covered by Medicare, however, if you have a new Ford, GM or Chrysler vehicle,
all of these companies will reimburse up to $1000.00 on the cost of a lift. Please see our
Lift Reimbursement page for more details.
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