Change in Medicare Reimbursement for Power Wheelchairs

Medicare Set-Aside Blog on November 18, 2006
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Due to rising costs in health care and increasing concern about Medicare’s solvency, CMS instituted a new policy on November 15, 2006, which reduced Medicare reimbursements for power wheelchairs by about 35%.

One fear is that suppliers will go out of business or not qualify as Medicare suppliers under this policy change. Prior to the change, Medicare was reimbursing up to $6,130 for standard power wheelchairs, expected to decrease to less than $4,000 as a result of this change. According to CMS, Medicare was reimbursing at rates significantly higher than market value, resulting in unnecessary federal spending as well as increased copayments for beneficiaries.

Although suppliers are unhappy about the new reimbursement rates, this should be considered a significant shift in Medicare policy. The baby boomer generation is expected to rapidly begin depletion of Medicare funds and CMS must find a way to protect funds for future generations. Medicare is the largest health insurer in the nation.

Effect on MSAs: Currently, the WCRC doesn’t consider Medicare’s reimbursement rates for MSAs of injured workers. However, this is representative of a trend CMS is following to further protect Medicare. If WCMSAs begin to account for Medicare’s reimbursement rates and/or if liability MSA protocol is eventually implemented, expect these prices to be reflected in future MSAs.

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