*Note: This is an informative article regarding what and how Medicare pays for equipment. Oswald’s does NOT bill Medicare, Medicaid, or insurance providers for goods or services.
We are often asked if we bill Medicare for medical equipment items. While the answer to that is ‘no,’ we always inform our customers what to watch out for if they decide to bill Medicare.
“Things to watch out for?” you may be thinking. And we would tell you that there are small clauses or rules Medicare uses that you need to think about. These items include only covering 1 rolling-stock item and 1 power item every 5 years, replacement, repair & warranty issues, and competitive bidding.
We can’t cover every individual situation, so it’s important to note that Medicare/Medicaid plans may make exceptions. There is a lot of paperwork involved for Medicare exceptions, so be prepared for some leg work if you decide to pursue rejected claims!
Medicare Payments Covering 1 Rolling Item and 1 Power Item Every 5 Years
The most common story we hear about Medicare claim rejections is a customer who buys a walker then needs a wheelchair—a wheelchair that won’t be covered. As wacky as this sounds (walkers and wheelchairs being considered ‘the same’ thing), it comes up frequently.
On top of manual mobility items (wheelchairs, walkers, etc), power mobility items like power chairs and scooters are lumped together in a different 1-every-5-years category. Power mobility items can be very expensive (custom power chairs can run over $30,000), so getting the ‘wrong’ item covered can be financially devastating.
As I said in the introductory section, Medicare is able to make exceptions to their billing policies, but it is very rare and very time-consuming. There are a few steps to take to make sure you get the right items covered.
Getting the Right Items Covered by Medicare
First thing is first—pay cash for ANY affordable items whenever possible. “Affordable,” in durable medical equipment terms, is any home medical product under $200. This figure may seem high, but one piece of medical equipment for a serious condition can end up costing thousands of dollars—and you don’t want to pay cash for that!
Mobility items we commonly tell people to pay cash for are standard walkers, canes, crutches, basic rolling walkers, and other basic mobility products. If there is any chance the condition or situation you’re dealing with will get worse, you need to consider medical equipment costs.
If you are in a situation where your ‘5 year period’ is over and you need new equipment, you will need to prove it. As harsh as this sounds, Medicare needs to know that the item is so worn down from day-to-day use that it can’t be fixed. To show this proof, you will need an order from your doctor or another Medicare-approved caregiver.
Lastly, a quick tip: If you are ever at the doctor or hospital for a minor injury MAKE SURE that you tell the doctor or caregiver to NOT bill Medicare for any equipment provided. We have heard this story all too many times—a customer can’t get a piece of equipment covered by Medicare, as they have already been issued a mobility aid. The customer can’t remember buying a walker, but they were issued one by the hospital after a fall. Yep, that walker is the 1 item for 5 years.
Medicare Replacement, Repair, and Warranty Issues
Medicare will not replace covered mobility products that are within the 5-year period. This includes items that have been broken or rendered unusable. Medicare will, however, cover repair and labor costs if they fall outside of a covered items warranty.
Repair and labor coverage stipulates that a Medicare-contracted technician must be used. If you have your next door neighbor Bob the Handyman fix your scooter, Medicare will not cover parts and labor. Finding a Medicare-contracted repair technician can be tough, so always call your retailer or local hospital first—they may have someone for you to call.
The good news is that most items Medicare pays for come with manufacturer warranties that cover most major issues for 2-5 years. You should save any documentation that comes with your medical device in case a repair becomes necessary.
Lastly, a quick purchasing tip: When you are selecting your Medicare-covered mobility item, always ask if the retailer has other covered options. If you can choose between a few different walkers or wheelchairs, be sure to check the manufacturer’s warranties. A good warranty can help make your decision easier!
Medicare/Medicaid Competitive Bidding
A medical industry ‘buzzword’ for years now, competitive bidding refers to the process of retailers giving bids to Medicare to see who can provide the best products, eligibility, and prices for consumers. This sounds good, right? Unfortunately, there can only be one bid winner per-category, per-region.
**We are listed on this site because we are contracted through Medicare with our pharmacy. We cannot bill Medicare for Durable Medical Equipment.
When you purchase a wheelchair, walker, or other ‘inexpensive’ item from a retailer that won a bid, you may encounter some issues. Bid winners for categories like wheelchairs offer 1 item per bid category. What this means is that you don’t get a choice of models, styles, or features.
Competitive bidding was introduced to stop Medicare fraud and the solution was to select a single vendor with the best unit and pricing. You can find different retailers with different bid winning items, but remember—it’s regional, so you might have to make a long trip.
The Benefits of Out of Pocket Medical Equipment Purchases
If you have the financial means, paying out of pocket offers the most advantages when it comes to medical equipment. Having your choice of any manufacturer, model, and retailer gives you some major advantages.
The biggest advantage when it comes to out-of-pocket medical purchases is having a retailer. If you get medical equipment through Medicare/Medicaid, you are the one that has to deal with problems, paperwork, and correspondence. If you buy from any retailer worth their salt, they will be the ones helping with warranty, repair, and other issues.
Paying out of pocket also gives you the freedom to select the unit you like the best. Being able to purchase a wheelchair with superior cushioning that fits your needs can help avoid years of slight discomfort.
Stop by Our Medical Equipment Showroom
We opened our Medical Equipment Showroom over 4 years ago to help people who were unable to bill insurance or Medicare/Medicaid. Our goal was to offer a great selection of product choices and let our customers find the one they like best.
Our team members are trained to help you find the best solution for your needs. We have dozens of wheelchairs, walkers, rollators, lift chairs, and mobility scooters unboxed and ready to test.
Wil has been working for Oswald’s since 1994. A 6th generation member of the Wickel-Oswald-Kester-Anderson family, Wil focuses on web development, inventory, and sales.
With over 10 years of experience selling durable and home medical equipment, Wil is an expert on helping people find what they need to use after major surgery or an accident.
Wil graduated with a BA in English Literature from Knox College in 2008, minoring in History.
A graduate of Naperville North High School in 2004, Wil is a lifelong Naperville resident and is currently a columnist for Positively Naperville.