Don't let misinformation get in the way of renewed mobility. Get the facts on how the Medicare process for power wheelchairs has changed with healthcare reform.
When healthcare reform became law in March 2010, many Medicare recipients feared it might have a negative impact on power wheelchair reimbursements. Fortunately, many of those concerns were unfounded.
The truth is, that even with changes brought about by healthcare reform legislation, existing and guaranteed Medicare benefits are protected under current provisions within the Patient Protection Affordable Care Act, or the PPAC Act1.
- Medicare - for the most part - still covers as much as 80% of the total cost for a prescribed motorized wheelchair2
- Secondary insurance may still pick up the remaining 20%
What has changed as a result of the new law is the way Medicare pays for electric wheelchairs. Below, are five essential truths about Medicare, healthcare reform and power wheelchairs that every senior and disabled individual needs to know.
Five Truths About Healthcare Reform and Medicare Power Chair Rentals
Truth # 1: As a consequence of healthcare reform, Medicare will no longer purchase power chairs with a lump sum payment. This was historically known as the first-month purchase option. But, on January 1, 2011, standard power wheelchairs became rental units only3, and must now be rented over a period of 13 months.
Truth # 2: Medicare will make 13 monthly payments for eligible beneficiaries, as long as the power chair is needed, and is used, within the home for mobility assistance during the rental period. Other conditions under which Medicare will discontinue paying for a rented power chair include long-term hospital stay or admittance to a rehab facility, a skilled nursing facility and/or hospice.
Truth # 3: Medicare beneficiaries may be billed by the power chair supplier on a monthly basis (for up to thirteen months) to cover any applicable co-pays and deductibles.
Truth # 4: The power chair remains the property of the mobility supplier for as long as it is being rented. If there is an interruption in payment, or if the recipient ceases to need the power wheelchair at any point during the 13-month rental period, the supplier will regain physical possession of the equipment.
Truth # 5: After all payments and reimbursements have been received, complete ownership of the power wheelchair is transferred to the Medicare beneficiary.
Requirements for Medicare Power Chair Reimbursement
It's important to note that healthcare reform has not affected the clinical requirements for Medicare power chair reimbursement. Even though the power chair is rented, Medicare still requires a face-to-face mobility examination, detailed documentation of medical necessity, a precise medical diagnosis, and a written order for a power wheelchair.
To learn more truths about Medicare's power wheelchair benefit, please contact a mobility specialist at 1-800-542-7236.
Additional information on Medicare policy and healthcare reform is available from the official Medicare website at www.medicare.gov/ or from the Center for Medicare & Medicaid Services at 1-800-MEDICARE (1-800-633-4227).
This article is for general information and educational purposes only. It is not intended as a substitute for professional medical advice. Specifics concerning Medicare regulatory policy may be obtained from the Center for Medicare & Medicare Services.
1 US Govt. House of Representatives (May 2010), Compilation of Patient Protection and Affordable Care Act (Public Law 111-148), Subtitle G - Protecting and Improving Guaranteed Medicare Benefits; Page 462, Sections 3601-3602 | Accessed: July 21, 2011 https://docs.house.gov/energycommerce/ppacacon.pdf
2 Insurance coverage depends on medical necessity as determined by the insurer and a doctor's diagnosis. The purchase and use of an electric wheelchair requires a valid doctor's prescription.
3 Standard power wheelchairs furnished to recipients living in the nine CBAs of Round 1 Rebid of the DMEPOS program are exempt from the rental requirement through 2013. Certain complex rehab power chairs are also exempt.