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What Is Advanced Determination Of Medicare Coverage?

Tips and important information for understanding what is advanced determination of Medicare coverage.

Many Medicare beneficiaries find themselves asking, “What is Advanced Determination of Medicare Coverage?” Advanced Determination of Medicare Coverage, also known as ADMC, is a program that allows beneficiaries to apply for and obtain advanced approval from Medicare for certain items before a beneficiary receives that item. The only items that are eligible to receive advanced approval, as of now, are customized wheelchairs. Just because a certain item was approved in advanced, does not guarantee that Medicare will absolutely pay for that item.

What Is Advanced Determination Of Medicare Coverage And How Does It Relate To Me?

If you are in need of a customized wheelchair, whether it is manual or electric, you may request that Medicare approve your receipt of the wheelchair before you actually receive it. While this does not guarantee whether Medicare will cover the cost of the wheelchair, it will give you a good idea of whether or not the expense will be covered and allow you to plan accordingly. For example, if ADMC denies coverage of the wheelchair, you may then decide on a price range that is affordable to you before receiving a wheelchair that is going to be out of the limits of your budget.


Am I Required To Apply For Advanced Determination Of Medicare Coverage?

No, while applying for Advanced Determination of Medicare Coverage is advantageous, it is not required. If for any reason, a beneficiary prefers that an advanced approval is not obtained, Medicare does not require that the beneficiary applies, nor that they will cover the cost of the item in question. For those who may find themselves in need of a wheelchair, understanding what is Advanced Determination of Medicare Coverage is important to ensuring optimal use of their Medicare program.



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