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. So, will Medicare pay for a wheelchair? The answer depends on a few factors, and certain conditions must be met for the coverage to apply. If you find yourself in need of a wheelchair, then 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. This coverage is provided through Medicare Part B. Remember that Part B 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 order for the wheelchair and the DME supplier of the wheelchair must both accept Medicare.
- Either the doctor or wheelchair supplier must visit your home and verify that you can safely use the wheelchair inside your home. 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 talk about the different types and the coverage details for each.
How To Get Your Wheelchair Covered By Medicare
Now that you know Medicare provides coverage for wheelchairs, you might be wondering what you need to do to get Medicare to pay for your wheelchair. There are a few steps you need to take to make sure 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 the documentation you provide.
You should receive a letter informing you of Medicare’s decision. If your wheelchair expense has been approved, you can go ahead and 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.
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.
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.
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.
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
The competitive bidding program is a program implemented by Medicare to save the program money. Under this program, specific durable medical equipment must be purchased from a Medicare-approved supplier. Many equipment items are included in this program, like 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 covered under the current rules of the competitive bidding program at this time. However, you can expect that wheelchairs will once again fall under the program’s rules in the near future.
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 costs 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 amounts, you might consider renting the equipment instead. 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 for a short time until Medicare gives you the final go-ahead to buy one. Regardless of the reason, just know that many medical equipment suppliers offer rental options, and a rental might just 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? There are a few other programs 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 that are 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 of them 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. If you are eligible for Medicare, you can sign up for a Medicare Advantage plan. You can use the plan finder tool at Medicare.gov to learn more about plans available in your area.
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 work directly with your medical equipment supplier 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 in your area and ask them about any available assistance programs.
The Bottom Line
As a basic part of Medicare, coverage for durable medical equipment is included. This means that Medicare will pay for the cost of a wheelchair. However, you will need an order from your healthcare provider that details the medical need for the device. You will also need to make sure that both your doctor and your 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 see what other types of financial assistance programs might be available.
Frequently Asked Questions
How much does Medicare pay for a standard wheelchair?
If the approval requirements are met, Medicare will pay 80% of the Medicare-approved amount for a standard wheelchair. This means that you will be responsible for 20% of the cost as long as you have already met your Part B deductible. Prices vary slightly between suppliers, so make sure the supplier you use accepts Medicare before making your purchase.
What diagnoses qualify for a wheelchair?
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 the device. These are the general medical guidelines that must be met, and there is no specific diagnosis that is required.
How long does Medicare take to approve a wheelchair?
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. You may call Medicare to get additional details if you have not received a decision on your request within ten business days.
What does the doctor need to do to have Medicare approve a wheelchair?
The doctor must provide a written order that details your medical need for a wheelchair. They must certify that you can use the type of wheelchair requested, and 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.