Wheelchair Options and Accessories

Accessory Requirements for Your Wheelchair

In order to get special equipment, such as wheelchair cushions, you must be able to show that you have an honest need for the equipment. Each type of equipment will have specific criteria that you must meet in order to qualify for it. You must have an order written by your doctor, and the reasons for needing the equipment must be documented in your medical record. For example, if you request:

Adjustable arm-height on your chair: You will have show that your arm height is different than that which is available on chairs with non-adjustable arms. You must also show that you spend at least two hours a day in the chair.
Reinforce back or seat upholstery: You must weigh over 200 pounds to be approved.
Accessories that support a particular body part: You must be able to show that the body part requires the extra support to function.

The following is a partial list of common wheelchair options and wheelchair accessories:

Reinforced back upholstery or seat upholstery
Hook-on headrest extension

How Much Do I Pay?
How much you pay will depend on whether or not you have Part B coverage and where you buy your equipment. However, in general, if you are enrolled in Medicare Part B:

You will pay a 20 percent copay, after you have paid your yearly deductible.
You will pay less out of pocket if you buy from a supplier who accepts assignment. You will have a 20 percent co-pay and Medicare will pay the other 80 percent.
You may owe little or nothing, if you have a Medigap policy.
You may have some restriction on which suppliers from which you can buy, if you receive you Medicare through a Medicare Advantage Health Plan. It is important to do your homework.

Read about the factors that affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you buy your equipment through an approved supplier that accepts assignment.

What are Wheelchair Options and Accessories and Does Medicare Cover Them?
Wheelchair options and wheelchair accessories are added on parts that customize a wheelchair so it will be more useful for people who have specific injuries, conditions or disabilities.

They must be medically necessary for Medicare to pay for them. Medicare considers wheelchair accessories medically necessary, if you need them to perform the activities of daily living in the home. Such devices include, but are not limited to: adjustable arm height; reinforced back upholstery; headrest extensions; fully reclining back; solid seat; various leg rest types; batteries and custom parts. Medicare will not cover the cost of an option or accessory if it is needed only for activities outside the home. You must have a written doctor's order and the supplier must have the order on file before billing for your purchase.

What types of Wheelchair Options and Wheelchair Accessories are Not Medical Necessary?
The following wheelchair items are considered not medically necessary:

Padded Back support systems with a plastic frame that attaches but does not replace the wheelchair back. Because these support systems do not provide trunk support they are not considered medically necessary.
A battery charger over and above what is supplied with your power wheelchair.
Any wheelchair accessory/attachment needed for activities outside the home, for convenience, for work, or to perform outside activities. Examples include the following:
- Wheelchair rack for automobile (auto carrier)
- Wheelchair baskets, bags, or pouches - used to hold personal belongings
- Crutch and cane holder
- Wheelchair ramp - provides access to stairways or vans
- Snow tires for wheelchair
- Flat-free inserts
- Shock absorbers

Where Can I Buy Wheelchair Options and Wheelchair Accessories?
You will save money if you order your item from a Medicare approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your items from any store that sells them. However, if the supplier from which you order is not enrolled in Medicare, Medicare will not pay for the equipment.

Things you should think about before you choose a supplier:

There are two types of Medicare suppliers, participating suppliers and those who are enrolled, but have chosen not to participate.

Participating suppliers must accept assignment, which means they agree not to charge more than the Medicare allowed amount and will collect 20 percent copay for the accessories. If you have a Medigap Supplemental Insurance plan, you might not owe anything.

A Medicare approved supplier who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up your purchase. In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple of months to receive payment.

If you receive your Medicare coverage through a Medicare Advantage Plan (HMO or PPO), it is likely that the plan will have its own steps for equipment purchases. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers -they cannot supply less.

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