Don’t Get Around Much Anymore? Medicare May Be Able to HelpPosted by Medicare Made Clear
Are you having a harder time getting around lately? You’re not alone. Many people report problems with balance, lower body strength and stamina as they get older. These issues can make it harder to stand, walk or do many things that you used to do with ease.
Devices like walkers, wheelchairs and scooters may make it easier to move around. In many cases, Medicare Part B or a Medicare Advantage plan will help cover some of the costs of this equipment.
Medicare will only pay for your durable medical equipment if your doctor determines that it’s medically necessary. He or she will help decide whether a walker, wheelchair or scooter is best for you.
The choice will depend on your condition and what would work in your home. For example, you wouldn’t want a wheelchair that doesn’t fit through the doorways in your house. And, your doctor would only prescribe a scooter if you’re strong enough to sit up and able to work the controls safely.
To be covered, the equipment must be needed for you to move around in your home. Medicare won’t pay for a device that you only need to use outside the home.
Medicare will only pay for a prescribed device if both your doctor and supplier are enrolled in Medicare. After you meet your Part B deductible ($166 in 2016), Medicare will pay 80% of the cost for your equipment as billed by the equipment supplier. You would be responsible for the remaining 20%.
It’s important to ask your supplier if they participate in Medicare and accept Medicare assignment before you buy or rent your equipment. Accepting Medicare assignment means that they agree to take the Medicare-approved amount as payment in full and not to charge you more than your deductible and coinsurance amount.
If your supplier participates in Medicare but doesn’t accept assignment, Medicare may pay less than the Medicare-approved amount. The supplier can then bill you directly for up to 15% of what Medicare paid, in addition to your regular 20% coinsurance. Ask first so you know what to expect and can look for another supplier if needed.
You may have to buy the equipment, you may have to rent it, or you may have the choice of renting or buying. Under Medicare rules, you would own your wheelchair or scooter after renting it for 13 months.
Finding a Supplier
Some areas of the country fall under Medicare’s Competitive Bidding Program. In these areas, Medicare has chosen qualified, accredited suppliers to provide certain medical equipment – such as wheelchairs, walkers and scooters – at a lower price than Medicare was previously paying. If you live in one of the areas included in the Competitive Bidding Program and have Original Medicare, you will need to get your equipment from one of these suppliers. (Medicare Advantage plans will have their own lists of approved suppliers.)
When you’re ready to start shopping, check out Medicare’s Find a Supplier page to locate a participating retailer near you.
Medicare Advantage or Other Insurance
A Medicare Advantage plan will offer at least the same amount of coverage as Original Medicare. Your out-of-pocket costs will vary depending on your plan and may be lower than with Original Medicare.
If you have another insurance plan that pays before Medicare, you may have to use a supplier who doesn’t participate in Medicare. In that case, Medicare may make a secondary payment to that supplier.
Help may be available for your mobility issues. Talk to your doctor about what device would work best for you, and take the time to understand exactly what’s covered under your plan.
For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.