Many people with mobility issues rely on wheelchairs to help them get around and perform their daily activities. Some people need a wheelchair permanently, while others might only need one temporarily while recovering from a condition or accident.
Wheelchairs can be quite expensive, especially electric wheelchairs or scooters. Will Medicare pay for a wheelchair?
The answer depends on a few factors, and certain conditions must be met for coverage to apply. If you need a wheelchair, keep reading. We will tell you everything you need to know about getting your wheelchair covered by Medicare.
Does Medicare Cover Wheelchairs?
Yes, Medicare covers wheelchairs through Medicare Part B, which also provides coverage for durable medical equipment.
Since wheelchairs are considered durable medical equipment, your Original Medicare coverage will pay for most of the cost of your wheelchair. However, certain conditions and criteria must be met before Medicare will cover these costs.
First, your doctor must write an order that the wheelchair is medically necessary for use in your home. Even with the doctor’s order, you must meet all of the following conditions.
- You must have a health condition that causes significant difficulty moving around your home.
- You must be unable to perform activities of daily living, even with the help of a cane or walker. These activities could include bathing, dressing, restroom use, or getting out of bed.
- You must be able to safely operate the wheelchair and get in and out of the wheelchair. Otherwise, you must have someone with you at all times who can help you operate the chair.
- The doctor who writes the wheelchair order and the wheelchair’s DME supplier must both accept Medicare.
- Either the doctor or wheelchair supplier must visit your home and verify that you can safely use the wheelchair inside. They will check for things like the width of your door frames, open floor spaces, and other items that could prevent the chair from being used.
If you meet all the criteria above, Medicare will pay 80% of the Medicare-approved amount for the wheelchair. You will be responsible for paying 20% of the cost of the wheelchair. Your Medicare Part B deductible will also apply.
There are several different types of wheelchairs available today, and Medicare will cover each type under certain circumstances. Later in this article, we’ll discuss the various types and the coverage details for each.
KEY TAKEAWAYS
- Medicare Part B, which provides coverage for durable medical equipment, also covers wheelchairs.
- To qualify for wheelchair coverage, you need a written order from a doctor outlining the medical need, plus find a Medicare-authorized supplier.
- If you are eligible for a wheelchair, Medicare will only cover 80% of the cost, and you will be responsible for a 20% copay.
How To Get Your Wheelchair Covered By Medicare
Now that you know Medicare provides coverage for wheelchairs, you might wonder how to get Medicare to pay for your wheelchair.
You need to take a few steps to ensure that Medicare will cover the cost of the wheelchair.
- First, you must get a written order from your doctor to get a wheelchair from Medicare. Make sure that your doctor accepts Medicare and ask for a written order that details your medical need for the wheelchair.
- Next, you need to find a medical equipment provider who accepts Medicare and complete a prior authorization request with Medicare. This should be done before you purchase the chair.
Your medical equipment supplier can likely help you with this process. You will provide documentation to Medicare, and they will make a coverage decision based on your provided documentation.
You should receive a letter informing you of Medicare’s decision. If your wheelchair expense has been approved, you can purchase the chair.
If Medicare denies your request, you can appeal their decision. There are several steps to the appeals process, and you might be able to overturn the denial. You can always call Medicare at 1-800-Medicare if you have not received a decision letter in the mail.
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Types Of Wheelchairs Included In Medicare Coverage
So, what types of wheelchairs will the Medicare program pay for? The answer depends on your specific need, but here are the three main types and details about coverage for each.
Manual Wheelchair
The manual wheelchair is the most basic type of wheelchair, and this is usually the first option for many Medicare beneficiaries. If you cannot move around with a cane but have enough upper-body strength to operate a manual wheelchair, this is likely the type of chair that will be approved. These wheelchairs require that you be strong enough to manually move the wheels unless you have someone with you who can push you in the chair. If the chair is only needed for a short time, you might consider renting a wheelchair instead of buying one.
Power Scooter
If you aren’t strong enough to use a manual wheelchair, you might be able to get a powered wheelchair or scooter. In recent years, these mobility aids have become very popular, but you need to meet a few more requirements to get one. First, you must be unable to operate a manual wheelchair. Next, you must be able to safely get on and off the scooter, and you must be able to sit up and operate the controls. Your equipment supplier can show you the different Medicare-approved scooters that are available. Power-operated scooter rentals are also an option if you do not have a long-term need for the device.
Electric Wheelchair
A power-operated wheelchair is the most difficult type of wheelchair to qualify for. There are a few extra criteria required to get power chairs covered by Medicare. You must be unable to operate either a manual wheelchair or a power scooter. Next, you must have a face-to-face exam with your doctor, and the doctor must determine that you have a medical need for the power wheelchair. Your doctor must submit a written order to Medicare stating why you require the power wheelchair and that you are capable of operating it safely.
Wheelchair Coverage And Medicare’s Competitive Bidding Requirements
Medicare implements a competitive bidding program to save the program money. Under this program, specific durable medical equipment must be purchased from a Medicare-approved supplier.
This program includes many equipment items, such as hospital beds, bedside commodes, and wheelchairs.
- Since the cost of these items is relatively high, getting this equipment from an approved supplier ensures that Medicare gets the best price possible.
Typically, wheelchairs would be included in Medicare’s competitive bidding program. However, the program is experiencing a temporary gap due to contractual issues. New contracts were implemented for the program in January 2021, but those contracts only apply to back and knee braces.
So, wheelchairs are not currently covered under the competitive bidding program’s rules. However, you can expect that they will once again fall under the program’s rules in the near future.
TIP
If you only need a wheelchair for a temporary medical condition, you may want to consider renting one instead of purchasing one. Medicare will cover up to 80% of the rental expense in certain situations.
Renting vs. Buying Your Wheelchair
The cost of wheelchairs and scooters is relatively high. Even though Medicare will provide coverage for these devices, your out-of-pocket expenses can still exceed $500 in many cases, depending on the type of equipment you need.
- For this reason, you might consider renting a wheelchair instead of buying one. This can be an excellent option for someone with only temporarily limited mobility.
Perhaps you are recovering from an accident or medical condition and will regain full mobility within a few months. Instead of spending hundreds or thousands of dollars in coinsurance, you might consider renting the equipment.
- Medicare may still cover 80% of the rental cost, and your out-of-pocket costs might be much lower.
- You might need to rent a wheelchair briefly until Medicare gives you the final go-ahead to buy one.
Regardless of the reason, many medical equipment suppliers offer rental options, and a rental might be the best option for you.
Other Financial Assistance Programs Available
Now that you know about the Medicare benefits available to help pay for a wheelchair, what other options exist? A few other programs are available that might help you pay for the cost of your wheelchair.
Medicare Supplement Plan (Medigap)
You could consider enrolling in a Medicare supplement plan (Medigap plan). These plans help cover out-of-pocket expenses not covered by Medicare Part A or Medicare Part B. These plans are managed by private insurance companies, and they cover items like your Medicare copays and deductibles.
Medicare Advantage Plan
You could also consider a Medicare Advantage plan. While these plans must provide at least the same level of coverage as Original Medicare, many go above and beyond traditional Medicare benefits.
Some of these extra benefits could include better coverage options for medical equipment, which would mean that wheelchair coverage would be better than it is with traditional Medicare.
You can sign up for a Medicare Advantage plan if you are eligible for Medicare. You can use the plan finder tool at Medicare.gov to learn more about plans available in your area.
Medicaid
If you have a financial need, you might also be able to get assistance with the wheelchair’s cost through your state’s Medicaid program. Since eligibility and coverage details vary from state to state, you should contact your state’s Medicaid office to learn more.
Medical Supplier Assistance
Finally, if you do not have health insurance, you can always contact your medical equipment supplier directly to learn about financial assistance programs that might be available.
Some suppliers may offer special discounts or payment plans that can help you with the cost of your wheelchair. You should find a supplier and ask them about any available assistance programs.
The Bottom Line
Medicare includes basic coverage for durable medical equipment. This means that Medicare will pay for the cost of a wheelchair.
However, you will need an order from your healthcare provider detailing the medical need for the device. You must also ensure that both your doctor and equipment supplier accept Medicare.
If you are strong enough to operate a manual wheelchair, that is likely what you will qualify for. But you might be able to get a power scooter or power wheelchair in some cases.
If you do not have medical insurance, you should contact suppliers to find out what other financial assistance programs are available.
Frequently Asked Questions
If the approval requirements are met, Medicare will pay 80% of the Medicare-approved amount for a standard wheelchair.
If you have already met your Part B deductible, you will be responsible for 20% of the cost.
Prices vary slightly between suppliers, so ensure your supplier accepts Medicare before purchasing.
Many diagnoses may qualify you for a wheelchair. Your doctor must certify that you have limited mobility and can’t get around your home easily enough to do daily tasks.
Your doctor must also verify that you can safely use the device, or someone else must be with you to help you use it. These are the general medical guidelines that must be met, and no specific diagnosis is required.
Medicare will respond to your authorization request within ten business days. If your health may be harmed if you don’t get the equipment immediately, your supplier can request that Medicare expedite their decision.
If you have not received a decision on your request within ten business days, you may call Medicare for additional details.
The doctor must provide a written order detailing your medical need for a wheelchair. They must also certify that you can use the type of wheelchair requested. A home visit may be required for certain types of equipment.
Once your doctor gives you the order, you should work with a Medicare-approved medical equipment supplier to get Medicare’s approval for the wheelchair.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
