Will Medicare pay for an electric wheelchair?
Whether you’re just turning 65 and getting ready to enroll for Medicare or you’re newly in need of a wheelchair, that’s an excellent question.
Below, I’ll go over everything you need to know!
Now off we go!
READ MORE: The Best Lightweight Electric Wheelchair
Power Wheelchair Medicare Coverage Guide
Does medicare cover wheelchairs? More specifically, do they cover POWER wheelchairs?
Short answer, yes…but with a lot of caveats. For your power wheelchair to be covered by Medicare, certain requirements must be completed.
- Your doctor must send a written order and other supporting medical documents to the power chair supplier stating you are medically in need of a power wheelchair.
- Before issuing the written order, the treating doctor must conduct a face-to-face mobility examination on you to verify your medical need for a power wheelchair.
- The supplier, on the other hand, should be able to receive the written order within six months after the evaluation.
- You, your physician, and your medical equipment provider must all be Medicare beneficiaries. Your doctor must be Medicare-enrolled. And your supplier must be Medicare-approved.
- You must be able to prove (both on paper and via face-to-face examination) that your medical condition interferes with your daily living activities AND that other assistive mobility devices, such as a walker or cane, aren’t helping enough.
FYI, “daily living activities” include everything from bathing and dressing to getting in and out of bed to using the restroom.
So make sure you let your doctor know about ALL of the activities that you’re having difficulty with to better increase your odds of getting Medicare to cover your power wheelchair.
But wait, let me tell you something. Even if you can meet ALL of the above requirements, there are STILL instances where Medicare will disapprove your request for a power chair. Let me explain why.
When won’t Medicare cover a power wheelchar?
If you have a medical condition like blindness or a deteriorating mental capacity, and it makes it unsafe for you to use a power wheelchair, whether at home or outside, Medicare will not approve the device.
Medicare will likewise not approve if you live in a house or apartment that’s too small for you to be able to use a power wheelchair.
You may need to have your home remodeled to let a wheelchair pass through blocked passages, narrow door openings, or upstairs before they’ll reconsider.
Medicare-Approved Power Wheelchairs
Okay, so you’ve read all of the above and determined that Medicare will most likely pay for your power chair. What now?
You can’t just rush out and grab the first one you see. Medicare has A LOT of rules regarding what they’ll cover, and there’s a whole hierarchy to consider.
In other words, you have to try X before you can get approved for Y, and you have to try Y to get to Z.
Types of Medicare-approved Mobility Assistive Devices
Medicare divides mobility aids into two types.
- Manual Wheelchair. If it’s not safe for you to use a cane or a walker, you may be eligible for a manual wheelchair.
- Rolling Chair/Geri-chair. You may be eligible for a rolling chair if a manual wheelchair can’t provide your medical mobility needs.
- Power-Operated Vehicle/Scooter. If you can’t use a cane or a walker, and you can’t operate a manual wheelchair, THEN (and only then) you may be eligible for a power-operated scooter.
If you can’t use a manual wheelchair at home, or if you’re not physically able to sit up and operate the scooter controls safely, you may be eligible for a power wheelchair.
Types of Medicare-approved Power Wheelchairs
Of course, once again, there are a few different types and a process to figuring out which is best for you.
- Standard power wheelchairs. These user-friendly power wheelchairs are easy to navigate around your home. They have comfortable and padded armrests, adjustable mounts, and cushioned seats. The best option for recovering patients who require supportive therapy after an accident or illness.
- Heavy-duty power wheelchairs. Built for people who weigh between 450 to 600 lbs. These have improved mobility support for easier maneuverability. Some have steel frames. Seat and hip width vary depending on their models or brands.
- Complex Rehabilitative Power Wheelchairs. These are designed to address a medically challenged individual’s complex mobility needs.
Here are some specific examples of Medicare-approved power wheelchairs and scooters:
- EWheels Folding Power Electric Wheelchair with 2Storage Bag EW-M45
- GO CHAIR, such as the GO CHAIR Pride Mobility Travel Electric Powerchair
- BUZZAROUND EX Extreme 4-Wheel Heavy Duty Long Range Travel Scooter
- Pride Jazzy Passport Folding Power Chair JZPASS.
- Drive Medical Cirrus Plus EC Folding Power Electrical Wheelchair
Where to Shop for Medicare-Approved Electric Wheelchairs and Scooters
For the elderly who are struggling with their daily activities, choosing the best mobility
assistive devices can give them newfound freedom.
At 1800Wheelchair, they provide expert advice for choosing the best mobility scooters and wheelchairs.
How to Find a Medicare-approved Electric Scooter Supplier in your area?
Medicare.gov has a DME directory so you can find a Medicare-approved electric scooter supplier.
How much does Medicare pay for your power wheelchair?
After you have met your annual deductible, Part B of Medicare covers 80% of the cost of your power wheelchair. And you pay the 20%, in addition to your annual Medicare premiums.
How often will Medicare replace a power wheelchair?
If your power wheelchair has worn out, Medicare will only replace it if you have had
the item in your possession for its entire lifetime. Usually, you can avail of a replacement five years after you began using the equipment.
How can I get a free power wheelchair from Medicare?
Part B (Medical Insurance) of Medicare covers POV (power-operated vehicles) such
as scooters. And DME (durable medical equipment) such as walkers and wheelchairs.
Medicare helps cover DME if your doctor submits a written order stating that you have a medical need for a wheelchair or scooter to be used at home.
How long does it take Medicare to approve a power wheelchair?
Within 45 days of the face-to-face exam, the doctor must send your medical records
and the prescription to a Medicare-authorized DME provider. The wheelchair provider will then consult with your physician to determine the best wheelchair for your needs.
Where can I find DME POV suppliers I can use in my area?
For a list of suppliers, you can use in your area, go to Medicare. gov/supplier. You can
also get this information by calling 1-800-MEDICARE (1-800-633-4227).
For anyone who is medically in need of a power wheelchair, here’s the truth. Medicare will
approve 80% of the cost of your power chair.
Just be sure what feature/s to look for in your mobility aids, and complete the requirements. Having a power chair that works best for you gives you confidence and that sense of self-reliance.
- Bunis, Dena. 2021. “Medicare Eligibility, Age, Qualifications and Requirements.” AARP. January 2021. https://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-eligibility.html.
- “Medicare.gov: The Official U.S. Government Site for Medicare | Medicare.” 2021. Medicare.gov. 2021. https://www.medicare.gov/.
- “Medicare’s Wheelchair & Scooter Benefit.” 2019. https://www.medicare.gov/Pubs/pdf/11046-Medicare-Wheelchair-Scooter.pdf.
What are your thoughts on this power wheelchair Medicare guide? Please share with us below!
Haley has been working with seniors and their caregivers for more than 17 years. She has held local and national leadership roles in a variety of senior services and senior care agencies. Today, she is a sought after writer specializing in topics for older adults, their family members, and professional caregivers. When she isn’t at her computer sipping coffee, you can find her hiking with her husband, son, and dog or trying a new cookie recipe in the kitchen. Follow her on LINKEDIN