Medicare generally only covers the most basic level of durable medical equipment (DME) to meet your medical needs. If you want additional features or upgrades, you may have to pay for them out of pocket. For example, Medicare will cover a power wheelchair that you need for home use, but if you request a special backrest or tilt function that is not medically necessary, you may need to pay for those features yourself.
That said, Medicare may pay for special features or upgrades when your doctor includes them in your DME order or prescription. In this case, your doctor should explain why your health condition justifies the additional feature. For example, if your doctor states that you do not have the strength or balance to lift a standard walker without wheels, Medicare should pay for a model with wheels.
If your supplier thinks that Medicare may not pay for additional features or upgrades, the supplier should have you sign a waiver form called an Advance Beneficiary Notice (ABN) before you get the items. On the ABN, you must check the box stating that you want the upgrades and agree to pay their full cost if Medicare denies coverage for them. Even if Medicare refuses the upgrade, it should still pay the amount it would have paid for the basic model of the equipment. You will then receive a bill for remaining costs.
If Medicare refuses to cover upgrades, and the supplier failed to provide you with an ABN, you do not owe the supplier for the added features.
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