Frequently Asked Questions

Understanding Medicare, Medicaid, and insurance can be confusing, especially when it comes to coverage for medical equipment like lift chairs and scooters. In recent years, these programs, including Medicare for those 62 and older, have made it harder to get reimbursement for items like ours. Private insurances and Medicare alike have all significantly lowered their reimbursement amounts and increased the documentation requirements for most categories of Durable Medical Equipment.

Unfortunately, this means that over 95% of the time, items such as mobility scooters, lift chairs, and certain wheelchairs aren’t covered. Because of this, we’ve decided not to file claims with Medicare, Medicaid, or private insurance. We want to be upfront about this and save you from any confusion or frustration.

We understand the significance of healthcare coverage and want to assure you that our dedicated staff will be available to help you explore alternative payments options, ensuring you find the right product that meets your needs as well as your budget. We welcome you to give us a call or come on down into our showroom to talk with us.

The following information is for informational purposes only.

Medicare Capped Rental

Medicare typically doesn’t directly buy most items but instead opts for a rental arrangement known as Capped Rental for the initial 13 months. In this setup, Medicare covers a monthly rental fee for a maximum of 13 months. Once this period concludes, ownership of the equipment is transferred to the Medicare beneficiary (You). At that point, it becomes the beneficiary’s responsibility to manage any necessary equipment service or repairs.

Many of the items we offer fall under this Capped Rental category. Examples include manual wheelchairs, mobility scooters, power wheelchairs, hospital beds, alternating pressure pads and mattresses,  nebulizers,  patient lifts, and trapeze bars.

Inexpensive or Routinely Purchased Items

Items categorized as inexpensive or routinely purchase can be purchased or rented which can include seat lift mechanisms, canes, walkers, crutches, commode chairs, home blood glucose monitors, bed rails, and traction equipment. 

While items in this category is available for purchase or rental, its important to note that if rented the total amount paid monthly cannot surpass the fee schedule purchase amount. 

The following information is for informational purposes only.

Medicare provides coverage for durable medical equipment (DME), including power-operated vehicles (scooters) and power wheelchairs. To qualify for Medicare coverage on DME, certain conditions must be met:

Your treating doctor must submit a written order affirming your medical necessity for a wheelchair or scooter for in-home use.

• You must have limited mobility and meet specific criteria:
• Your health condition significantly hinders movement within your home.
  Activities of daily living, like bathing, dressing, or using the bathroom, are challenging even with the assistance of a cane, crutch, or walker.
  You can safely operate and get on and off the wheelchair or scooter, or have someone available to assist you.
  Both the doctor treating your condition and your supplier must be enrolled in Medicare.
• The equipment must be usable within your home, fitting through doorways and navigating your home without hindrance.

In terms of costs, you are responsible for paying 20% of the Medicare-approved amount after fulfilling your Medicare Part B deductible for the year. Medicare covers the remaining 80%. If you’re in a Medicare Advantage Plan, such as an HMO or PPO, you need to contact your plan to inquire about costs and approved DME suppliers.

The following information is for informational purposes only.

Coverage for a manual wheelchair designated for indoor use (E1037, E1038, E1039, E1161, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, K0009) is contingent upon meeting the following criteria:

1. Criteria A, B, C, D, and E must be satisfied.
2. Additionally, either Criterion F or G must be met.

The beneficiary must have a mobility limitation significantly impacting their participation in one or more mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing within the customary locations in the home. A mobility limitation is one that:

• Prevents the beneficiary from completing an MRADL entirely, or
• Places the beneficiary at a reasonably determined heightened risk of morbidity or mortality when attempting an MRADL, or
• Prevents the beneficiary from completing an MRADL within a reasonable time frame.
  Moreover, the mobility limitation cannot be adequately addressed by the use of a properly fitted cane or walker.
• The beneficiary’s home must offer sufficient access between rooms, maneuvering space, and surfaces compatible with the provided manual wheelchair.

The use of the manual wheelchair should significantly enhance the beneficiary’s ability to engage in MRADLs, and the beneficiary must express a willingness to regularly use it at home. The beneficiary must possess adequate upper extremity function and other physical and mental capabilities to safely self-propel the manual wheelchair throughout a typical day. Factors such as strength, endurance, range of motion, coordination, pain presence, and the absence of one or both upper extremities are relevant to the assessment of upper extremity function.

Furthermore, the beneficiary should have a caregiver available, willing, and capable of providing assistance with the wheelchair.

The following information is for informational purposes only.

Medicare extends coverage solely to the seat-lift mechanism and not the actual chair or furniture component. The reimbursement amount, ranging from $170 to $250, varies by state  when the coverage criteria are satisfied. A lift chair is deemed medically necessary if the following criteria are met:

Specific Medical Conditions:

• The beneficiary must have severe arthritis of the hip or knee or a severe neuromuscular disease, documented by a physician.

Physician’s Prescription:

• The seat lift mechanism must be part of the physician’s treatment plan, prescribed to bring about improvement or to halt or slow deterioration.

Functional Limitations:

• The patient must be completely unable to stand up from a regular armchair or any chair in their home.
• Once standing, the patient must possess the ability to walk, even with the use of a cane, walker, or other assistance. Notably, Medicare won’t cover this item if the beneficiary already has a wheelchair, scooter, or power wheelchair on file.

Justification Standards:

• Difficulty or incapacity to rise from a chair, especially a low one, is not considered sufficient justification for a seat lift mechanism according to Medicare standards. Most beneficiaries capable of walking can rise from an ordinary chair with appropriate seat height and arm support.

Physician’s Role:

• The physician prescribing the seat lift mechanism must be the attending physician or a consulting physician for the disease or condition necessitating the seat lift.

For those interested in pursuing Medicare billing for their lift chair, contacting Medicare at 1-800-MEDICARE is advised.

For over 35 years, CareCredit has been a trusted source of specialized financing for healthcare, empowering millions to access desired health and wellness products and services.

CareCredit offers a dedicated health, wellness, and personal care credit card, providing an effortless way to acquire home medical equipment today such as scooters and power wheelchairs. With the CareCredit healthcare credit card, you can conveniently manage payments within your budget.

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