Does Medicare Cover Wheelchairs?
Medicare Part B covers the majority of your wheelchair cost if your primary care physician or healthcare provider writes an order for one. You doctor’s order should state that:
- You have a medical condition which causes mobility issues that prevent you from taking care of your daily needs.
- You are capable of safely operating the type of equipment you are requesting, or you have someone who lives with you that can help you use your wheelchair when you need it.
- Your doctor and medical equipment supplier are authorized Medicare providers.
- You can use the device in your home without risking injury or accident.
What Kind Of Wheelchair Does Medicare Cover?
There are three basic types of wheelchairs: manual wheelchairs, power wheelchairs, and power scooters. (source) The type of wheelchair Medicare will cover depends on your physical condition and your doctor’s suggestions.
If you are capable of getting into and out of a manual wheelchair, as well as strong enough to operate one, you may qualify for one. If your mobility issues are temporary, such as you just having received knee replacement surgery, and you may be up and walking again soon, consider renting the equipment instead of purchasing it.
Your doctor will need to examine you in order to determine whether or not you need a power wheelchair. They will then need to write an order saying you’re capable of using a power wheelchair safely and explain why exactly you need one. You may need Medicare’s approval before purchasing or renting the device, so a prior authorization request has to be supported by the doctor’s order and medical forms provided by your medical equipment supplier.
You or your medical equipment supplier can submit the paperwork to your Durable Medical Equipment Medicare Administrative Contractor and you should receive a decision 10 days after you apply. If Medicare does not approve the purchase, you can appeal the decision.
If you are unable to use a manual wheelchair, Medicare may pay for a power scooter so long as you have an in-person visit with your doctor to confirm that you are capable of getting in and out of the scooter on your own and hold yourself upright while driving it. Just like all of these devices, it is best to deceive whether you should rent or buy the equipment.
If you want to see if your desired wheelchair is covered by Medicare and see if you qualify, visit the Medicare Wheelchair and Scooter Benefit.
How Much Does A Wheelchair Cost With Medicare?
With Part B, charges for a wheelchair under certain conditions as durable medical equipment are fully covered. If your mobility issue is temporary, you should consider renting your mobility device. There is a 20% coinsurance you generally have for a wheelchair under Medicare Part B, but Medicare Supplement insurance plans from private insurance companies can help greatly with those costs.
For example: If you have a power wheelchair worth $4,000, you may have to pay $1,000 in coinsurance. With a Medicare Supplement plan, you may only be responsible for $500. Some Medicare Supplement plans cover 100% of the Medicare Part B coinsurance cost, but you may pay an additional premium to have a Supplement Insurance plan.
Which Medicare Plans Are Best If You Need A Wheelchair?
If you need a wheelchair and you’re eligible for Medicare, it’s best to understand which plan best suits your needs.
- Medicare Part A covers hospitalization, so if you need a wheelchair during a hospital stay or while in a nursing home, the facility will provide you with one.
- Medicare Part B covers medical services, and wheelchairs are covered as durable medical equipment under this plan.
- Medicare Part C is also known as Medicare Advantage, and covers the same benefits as Plans A and B.
- Medicare Part D covers prescription drugs, so wheelchairs are not included under this Medicare plan.
- Medigap plans are supplemental plans which help pay for costs that Medicare does not cover, including some of all of the expenses of a wheelchair.
Does Medicare Cover Other Mobility Aids?
Medicare Part B pays for 80% of other mobility aids, such as walkers, rollators, canes, or crutches after your deductible has been paid. You will need to pay the other 20% of the cost and your doctor will need to write an order saying that the mobility device is medically necessary.
A Patient Lift
If your doctor thinks you need a lift to get from your bed into your wheelchair, Medicare Part B will cover 80% of that cost and you will be responsible for the remaining 20%.
A Wheelchair Ramp
Although a wheelchair ramp may be seen as medically necessary, Medicare Part B does not consider it durable medical equipment and the cost is not covered. If you are thinking about installing a wheelchair ramp, you will have to pay for it fully out of pocket.