Understand the Guidelines for Medicare Wheelchair Coverage
For many people, wheelchairs and other mobility devices are important for everyday mobility. Whether you need a wheelchair for a short period of time after an injury or procedure or you use one regularly, it’s good to know your Medicare coverage options for wheelchairs.
Wheelchairs are considered durable medical equipment under Medicare. This means that Medicare pays for wheelchairs if you meet the eligibility requirements. However, the portion of the costs you’re responsible for will vary based on your specific Medicare coverage. Read on to learn how you can get a wheelchair covered by Medicare.
Key takeaways:
If it’s medically necessary and your doctor prescribes it, Medicare helps cover the cost of a wheelchair.
Make sure you rent or purchase the wheelchair through a supplier that is enrolled in Medicare to receive coverage.
Medicare Advantage plans will cover wheelchairs, but your out-of-pocket costs may vary and the approved suppliers may be different.
Will Medicare pay for a wheelchair?
Yes, Medicare will help pay for a wheelchair if you meet the eligibility requirements. Keep in mind that your wheelchair won’t be completely free with Medicare. You’ll still have to pay some out-of-pocket charges, just like you would if you went to the doctor. We’ll go over what your out-of-pocket costs would be with Original Medicare and Medicare Advantage later in this article.
The only time Medicare will not cover a wheelchair is if you are denied prior authorization. You may need prior authorization for certain types of power wheelchairs. In this situation, Medicare denies prior authorization if they believe you don’t medically need a power wheelchair or if they don’t have enough information to approve the cost. You may also need prior authorization for any type of wheelchair if you have a Medicare Advantage plan.
Types of wheelchairs that Medicare covers
Medicare covers the following types of wheelchairs for different abilities and mobility levels:
Manual wheelchairs: a manual device for those that can’t use a walker or cane safely, but have the upper body strength or the help to use a manual wheelchair
Power-operated vehicle/scooter: a motorized mobility aid for those who can’t use a walker, cane, or wheelchair safely
Power wheelchairs: an electrically powered wheelchair for those who don’t qualify for a power-operated scooter and need more support than a manual wheelchair
What are Medicare’s guidelines for wheelchair coverage?
There are two general guidelines for wheelchair coverage. You have to meet the criteria to receive coverage and make sure your doctor and medical equipment supplier are enrolled in Medicare.
Eligibility requirements for Medicare wheelchair coverage
Medicare will only pay for a wheelchair if your doctor determines it’s medically necessary. You have to meet with your doctor face-to-face so they can assess your mobility needs, and you’ll need a written prescription.
Generally, your doctor will confirm coverage if you have limited mobility and you meet all of the following eligibility requirements:
You have a health condition that limits your ability to move around the house
You can’t perform daily activities with the help of a crutch, cane, or walker
You can safely operate and get on and off a wheelchair or scooter or have someone to help you
Your doctor or supplier visits your home at some point and verifies that you can use the equipment effectively
Your doctor and supplier accepts Medicare
Renting or purchasing a wheelchair through a supplier enrolled in Medicare
To receive coverage for a wheelchair or scooter, you must purchase or rent the equipment through a supplier that is enrolled in Medicare. Otherwise, you may have to pay for a wheelchair yourself.
Before you get your wheelchair:
Check that your supplier accepts Medicare
Make sure that your supplier also accepts assignment, which means that they can only charge you the Medicare-approved amount
If you need prior authorization for a power wheelchair, the supplier will submit the documentation on your behalf. To easily find a supplier that accepts Medicare, use the search tool on Medicare.gov.
How much do you pay out of pocket for a wheelchair with Medicare?
After you meet your Part B deductible, you’ll pay 20% of the cost of the Medicare-approved amount of the wheelchair.
For example, let’s say the Medicare-approved cost of a wheelchair is $2,000. Medicare Part B covers 80% of the Medicare-approved amount for DME. So, in this case, Medicare would cover 80% of $2,000, which equals $1,600.
You would be responsible for the remaining 20%. Therefore, your coinsurance would be 20% of $2,000, which equals $400. A Medicare Supplement plan will reduce your coinsurance.
How often will Medicare pay for a wheelchair
In case you lose your wheelchair or it becomes defective or damaged, Medicare covers any durable medical equipment once every five years.
Medicare Advantage and wheelchair coverage
While Medicare Advantage plans will pay for a wheelchair, the process can be a little trickier. Medicare Advantage plans operate through private insurers and out-of-pocket costs vary. This means what you pay for a wheelchair could be more or less expensive depending on your plan. Other things to keep in mind about Medicare Advantage plans:
Medicare Advantage plans require prior authorization more often than Original Medicare. This could cause delays in getting a wheelchair or even result in lack of coverage if your request is denied.
Your plan may have different approved suppliers than Original Medicare. Contact your plan to find out which suppliers are covered.
If you have a Medicare Advantage plan, you should always check your summary of benefits or get in touch with your provider’s billing department for information about specific costs and coverage.
Understanding your Medicare coverage for wheelchairs
There’s a lot of information to synthesize about how Medicare covers wheelchairs and what your requirements are. A licensed Medicare Advisor can help you break down the costs associated with a wheelchair and other durable medical equipment. Let a Chapter Advisor simplify your coverage details by calling us at 855-900-2427 or scheduling a time to chat.