Does Medicare Cover Electric Wheelchairs?
Electric wheelchairs are good for people who are unable to get around easily due to a serious injury or illness. They’re also more convenient than manual wheelchairs because they’re easier to maneuver and control and can be operated independently without assistance.
People with electric wheelchairs enjoy increased freedom to care for themselves, work, visit friends, shop, and enjoy social events with little or no help from caregivers. The increased independence can improve mental health and lead to a more positive outlook on life.
Below, learn everything you need to know about Medicare coverage for electric wheelchairs.
Key Takeaways
Electric wheelchairs, also known as power wheelchairs, are a type of durable medical equipment (DME) that improves the quality of life for people with mobility challenges.
Medicare covers electric wheelchairs when they are prescribed by your doctor as medically necessary for use inside the home.
After clearing the approval process, Medicare pays 80% of the approved amount. The remaining 20% is what you owe as coinsurance. If you have a Medicare Supplement plan, you’ll owe less.
Who needs a power wheelchair?
Electric wheelchairs are easy to use in your home. Their small turning radius makes them usable even in small spaces. They are especially useful for people with motor disabilities, like:
Muscular dystrophy
Multiple sclerosis
Cerebral palsy
Parkinson's disease
Spinal cord injuries
Strokes
Traumatic brain injuries.
Power mobility devices are also an option for people with chronic fatigue, cardiopulmonary disease, limited trunk stability, or obesity.
Does Medicare pay for electric wheelchairs?
Medicare considers wheelchairs durable medical equipment (DME) that your doctor prescribes for use at home to accommodate your medical needs. Wheelchairs, including electric wheelchairs, fall under this category and are covered by Medicare Part B.
Traditional Medicare (Parts A and B) tends to cover the most cost-effective solution for your specific medical needs. To receive coverage for an electric wheelchair, you must go through an approval process that deems this type of equipment medically necessary rather than a less expensive rollator, manual wheelchair, or motorized scooter.
Like Original Medicare, Medicare Advantage plans cover electric wheelchairs. How much you pay varies by plan.
What types of power wheelchairs are there?
An electric wheelchair, also commonly referred to as a power wheelchair, is a motorized mobility device with a battery-powered motor and a control stem.
Some power wheelchairs are designed to be more robust and heavy-duty, suitable for outdoor use. They are often customized with features, such as better suspension systems, a swivel seat, or a variety of sitting and standing positions.
However, these high-end wheelchairs are unlikely to be paid for by Medicare as they don't meet the "medical necessity" requirements. Wheelchairs covered by Medicare are typically prescribed for use within a home, with the sole purpose of improving mobility and assisting with activities of daily living.
What kind of wheelchair will Medicare pay for?
Medicare will only cover a wheelchair if it's considered medically necessary. This means it's needed to treat a medical condition. The main criteria for approving a power-assisted chair are:
You must be unable to use a manual wheelchair, cane, crutch, or walker safely.
Your doctor must document your medical condition and why an electric wheelchair is necessary for your use in your home.
How much will Medicare pay for an electric wheelchair?
Power wheelchairs generally cost between $1,500 and $3,000, whereas high-end, customized models could cost upwards of $10,000, depending on features.
Medicare Part B can cover 80% of the approved amount for the electric wheelchair. This leaves you responsible for the remaining 20% (this is your coinsurance) once you’ve met the Part B deductible. If you have a Medicare Supplement (Medigap) plan, your coinsurance might be reduced or eliminated.
Medicare will only pay for the Medicare-approved amount. This means you’ll owe extra for upgrades.
What Medicare agrees to pay is subject to change. For example, in 2023, Medicare decided to cover seat elevation devices that make transfers from the chair to a toilet, bed, or standing position easier and less painful. The Centers for Medicare and Medicaid Services listened to public appeals and judged seat elevation devices as a medically necessary upgrade that they would pay for.
Medicare will not pay for features such as 4-wheel drive, advanced seat adjustments, specialized controls beyond a standard joystick, or enhanced suspension. They will also not pay for luxury features like upgraded upholstery, advanced entertainment systems, or specialized aesthetic designs.
If you want additional features, your DME supplier can let you know what your Medicare plan is likely to cover. Your supplier may ask you to sign an Advance Beneficiary Notice (ABN), which indicates you will be responsible for any additional costs not covered by Medicare.
How do you qualify for an electric wheelchair?
For Medicare to pay for an electric wheelchair, you must meet its requirements.
First, you need a written order from your doctor to make the case for your eligibility. After a face-to-face examination of your condition, your primary care physician must provide detailed documentation of your medical condition, functional limitations, and why an electric wheelchair is required.
The appointment should take place no more than 45 days before the order date to ensure the information is current.
The order should note:
Your health makes it very hard to move around in your home, even with the help of a walker or cane
It is difficult for you to perform activities of daily living (such as bathing and dressing) in your home
You cannot use a manual wheelchair or scooter, but can safely use a power wheelchair or scooter
The wheelchair will help with a specific medical condition or injury and be used inside the home
Other considerations include:
Are you able to safely operate an electric wheelchair?
Can you use the wheelchair in your home?
Is your home accessible?
The next step is for you to take the prescription to a Medicare-approved DME supplier. Your supplier will prepare the paperwork required by Medicare.
How long does it take Medicare to approve an electric wheelchair?
The time it takes for Medicare to approve an electric wheelchair can vary depending on the complexity of your case and the completeness of your documentation. It can take several weeks or even months.
Your DME supplier will work with you to make sure that the vehicle you choose has the weight capacity, seat width and comfort, turning radius, and other features that meet your needs. Once you have made your selection, they will submit the paperwork.
You may also need a home assessment to make sure you can effectively use a motorized wheelchair in your home. An evaluator, often an occupational therapist, will come to your home to assess its layout and physical features to determine if it's suitable for a wheelchair. They will take measurements and look for access points, stairs, and other characteristics that might affect your use of a power chair.
Then, you may have to wait another 10 business days to receive prior authorization from the Durable Medical Equipment Medicare Administrative Contractor.
How does competitive bidding affect your Medicare electric wheelchair coverage?
Medicare uses a competitive bidding program for certain DMEs, including power wheelchairs. This means that Medicare contracts with certain suppliers in your area to provide these items. You must obtain your wheelchair from a Medicare-contracted supplier to receive coverage.
How to get an electric wheelchair for free?
Unfortunately, Medicare doesn’t pay for the entire cost of electric wheelchairs. Once you’ve met your Part B deductible, you are responsible for 20% of the cost (as coinsurance).
States have assistive technology programs, individual grants, and Medicaid programs that might help you obtain a power-operated vehicle. Local Councils on Aging may have equipment to loan or have connections to local charities.