What wheelchairs does Medicare cover?
How many will they pay for (if any)?
If you’re a new wheelchair user- or even a new Medicare recipient, keep reading.
We’ll cover everything you need to know about getting a set of wheels for free from your insurance.
CHECK: Top Recliners for Seniors
Table of Contents
What Wheelchairs Does Medicare Cover?
Medicare part B coverage provides the needed durable medical equipment (DME).
This typically includes coverage for wheelchairs, scooters, and other mobility equipment that you need to get around.
Before you receive DME, it is crucial to check with your medical equipment supplier to see if they are enrolled in Medicare. Assignment means the medical supplier can cost you only coinsurance and Part B deductible health plans.
There are no limits on how much your contract supplier might charge you if they are not willing to participate in your assignments.
Let’s look at what wheelchairs are covered by Medicare as well as its wheelchair medical insurance and coverage requirements.
READ MORE: Will Medicare Pay for a Wheelchair Ramp?
Types of Wheelchairs Covered by Medicare
Depending on your mobility level, your plan will cover which type of wheelchair is medically right for you.
Power wheelchairs, power scooters, and standard manual wheelchairs are the most common type of equipment used today.
Some physicians might recommend a manual wheelchair if you have upper body strength and a person to assist at home with mobility issues.
Your doctor could also recommend an electric wheelchair for severe disabilities and cannot sit in a power scooter.
Here are the procedures to meet the coverage conditions:
- Bring a healthcare professional with you to the office (PCP).
- Confirm with your PCP that you can operate a motorized wheelchair.
- Your PCP should ensure that you are able to support yourself while sitting in a power wheelchair.
Your doctor will write you a recommendation for coverage of a power wheelchair if you match all the criteria above.
In addition, wheelchairs and scooters are available for rent or purchase among the coverage options. The decisions about insurance are yours.
ALSO READ: Outdoor Motorized Wheelchair For the Elderly
How to Get a Wheelchair From Medicare
Doctors and medical equipment suppliers must consistently meet eligibility requirements to become eligible for enrollment and extend their participation in the program.
They can refuse to pay claims if one or both individuals are not enrolled in Medicare.
If the supplier agrees to take the Medicare-approved amount as payment for the service or product, then the client accepts the assignment.
Medicare could only pay 80% of the amount that has been approved. In this situation, the person has to pay the remaining 20%.
READ MORE: How Veterans Can Get a Free Wheelchair?
When Does Medicare Cover Wheelchairs
A wheelchair covered benefit by Medicare Part B if your PCP or the doctor provides you a prescription. Your doctor’s prescription will emphasize that:
- A medical condition is impeding your ability to care for your daily living and has difficulty with mobility.
- It is safe for you to use the equipment alone, or you have someone in your home who is always on hand to support you.
- Both the doctor and the equipment supplier are Medicare-authorized.
- You can use the equipment safely in your house without risking injuries and other impediments in your day to day activities.
READ MORE: How Often Will Medicare Pay for a Wheelchair?
How Many Wheelchairs Will Medicare Pay for?
If you have a wheelchair, your life will be drastically changed.
However, you’ll have to consider the cost of wheelchairs.
Many new wheelchair users worry about this: what wheelchairs does Medicare cover? We are here now to help you answer this question.
In order to qualify for wheelchair coverage, you must not have mobility issues that negatively impact your daily activities when you are away from home.
Find out if you are eligible for medical insurance, and if so, which of the plan options is right for you. Let’s get into it.
READ MORE: What Diagnosis Qualifies for a Wheelchair?
Wheelchair Insurance Coverage
Because DME is essentially a prescription, wheelchairs and other durable medical equipments (DME) are technically a medical necessity.
To cover such types of wheelchairs, the Medicare Part B prescription drug coverage must be paid for by the patient.
In addition to wheelchairs, Medicare Part A also covers wheelchairs, but ONLY if you need a wheelchair while you’re in the hospital.
All Medicare Advantage plans must provide the same benefits. In other words, it has the same wheelchair coverage as the public Part A and Part B coverage.
Moreover, Medigap policies can help you pay for wheelchair supplies, even if your usual plan doesn’t cover durable medical equipment (DME).
RELATED: Power Chair vs Scooter: What are the Differences?
Medicare’s Competitive Bidding Program
Under the competitive bidding program, a number of different types of durable medical equipment are purchased through open bidding.
Additional assistance such as hospital beds and commodes are also covered in the program.
You will need to purchase a wheelchair from an approved provider if you live in an area covered by the competitive bidding program.
This is important, as they could stop covering costs related to your wheelchair or motorized scooter if you decline strict standards and costs for coverage associated with your treatment.
READ MORE: 10 Best Lightweight Foldable Wheelchair
Out-of-pocket Costs for Wheelchairs Under Medicare
If you want to know the cost of a wheelchair or electric scooter, you can visit a primary care physician for an estimate. Fortunately, a trusted source, Medical News Today gives us an overview.
The average wheelchair cost can be affected by a number of things, such as:
- other insurance company
- the doctor charges by prescription
- whether or not the doctor agrees to act as a collaborative partner
- type of facility
- where one decided to purchase DME
As per Medical News, the patient will have to pay 20% of the approved cost if a DME supplier accepts the assignment. In addition, Part B’s annual deductible applies.
Wheelchairs come in various shapes and sizes depending on the medical services and chronic health condition that necessitates their use.
Alternatively, they will have the option of either renting or purchasing the equipment.
How often can you get a wheelchair from Medicare?
A wheelchair is eligible for replacement or refund if it is lost, stolen, damaged, or used for more than 5 years. For rentals, Medicare pays each month for equipment.
Can I get a grant for a wheelchair?
Yes! A lot of wheelchair grants are accessible to people in need of financial aid. All types of non-profit organizations and community groups offer grants.
Does Medicare pay for wheelchairs?
Yes! As long as you have Medicare Part B, you will get compensated if you meet your deductible and have a doctor’s prescription.
If you have a health condition that affects your mobility, you will only have to pay for 20% of the costs if you use Medicare Part B.
The amount you owe (plus your deductible, premiums, and copayments) must be paid for the remaining 20% of the cost.
Wheelchairs are covered by health insurance plans including additional coverage, regardless of which type of wheelchair is used.
Before getting a wheelchair, make sure that your doctor and medical equipment supplier are both enrolled in Medicare.
- BraunAbility. 2021. “Does Medicare Pay for Wheelchairs?” BraunAbility. BraunAbility. June 3, 2021. https://www.braunability.com/us/en/blog/funding-and-financing/does-medicare-pay-for-wheelchairs.html.
- Joy, Rebecca. 2020. “What Does Medicare Pay toward the Cost of Wheelchairs?” Healthline. Healthline Media. April 2, 2020. https://www.healthline.com/health/medicare/does-medicare-pay-for-wheelchairs#when-they-are-covered.
- Ledbetter, Sherri. 2021. “Does Medicare Pay for Wheelchairs?” Medicalnewstoday.com. Medical News Today. June 9, 2021. https://www.medicalnewstoday.com/articles/does-medicare-pay-for-wheelchairs#requirements.
- “What Medicare Covers | Medicare.” 2021. Medicare.gov. 2021. https://www.medicare.gov/what-medicare-covers.
What wheelchairs does Medicare cover? Have you tried applying for one? Please share your experiences below!