Will Medicare Provide Coverage for Wheelchairs?

A wheelchair can be a crucial aid to enable individuals with mobility impairments to maintain independence and quality of life. However, the cost of a wheelchair can be prohibitive, making it challenging for many seniors and individuals with disabilities to access the mobility aids they need. Medicare covers a wide range of medical services and equipment, including wheelchairs.

Still, it is essential to understand the coverage options and requirements to obtain the necessary mobility aids. So, does Medicare cover wheelchairs? In this article, we explore the question and provide valuable information to help navigate the process.

Will Medicare pay for a wheelchair?

Original Medicare provides 80% coverage for many types of wheelchairs. Medicare Advantage plans, private insurance companies approved by Medicare, often provide additional benefits and services beyond Original Medicare. Some Medicare Advantage plans may offer coverage for wheelchairs that Original Medicare does not cover, such as motorized scooters. However, individuals need to review the plan's coverage options and requirements to ensure they qualify.

Additionally, Medicare Supplement plans, or Medigap, may cover the remaining 20% of coinsurance payment for Original Medicare-covered wheelchairs. Understanding the different plans and their coverage options can help to make informed decisions and access the necessary mobility aids to maintain their independence and quality of life.

Individuals must acquire the wheelchair from a Durable Medical Equipment business that participates with Medicare and accepts the Medicare approved fee schedule.

Wheelchair vs. scooter

While both a wheelchair and a scooter are mobility aids, they differ. An individual or a caregiver typically pushes a wheelchair, which is available in manual or electric versions.

Conversely, a scooter is typically powered and operated by the user. Medicare may cover only one type of mobility aid, depending on the individual's needs and the diagnosis from a healthcare provider.

Medicare-approved wheelchairs

For manual wheelchairs, Medicare may cover the cost of a basic wheelchair with standard features such as footrests and armrests. However, the individual requires additional features such as tilt-in-space or reclining capabilities. If other elements are added to the chair, they may need to pay extra for these features.

For electric wheelchairs, Medicare typically covers the cost of a basic model meeting its coverage criteria. This includes an electric wheelchair with four or more wheels and a maximum speed of five miles per hour. However, if the individual requires a more advanced model, they may need to pay additional out-of-pocket costs.

Manual wheelchair

A manual wheelchair is an aid for individuals with limited mobility who require assistance getting around. Medicare's coverage for manual wheelchairs typically includes the cost of a basic model that meets their coverage criteria. This includes standard features such as footrests and armrests. However, additional features may require out-of-pocket payments.

It is important to obtain a prescription from a healthcare provider and ensure the manual wheelchair meets Medicare's coverage criteria to avoid unexpected costs. Medicare may cover 80% of the price of a manual wheelchair. The individual is responsible for the remaining 20% coinsurance payment after the Part B deductible is met.

Electric wheelchair

An electric wheelchair can significantly improve the quality of life for individuals with limited mobility. Medicare's coverage for powered wheelchairs typically includes the cost of a basic model that meets coverage criteria, such as a model with four or more wheels and a maximum speed of five miles per hour. If an individual requires a more advanced model, they may need to pay extra.

To avoid additional costs, obtain a prescription from a healthcare provider and meet Medicare’s coverage criteria. Medicare may cover 80% of the cost of a motorized wheelchair, with the individual responsible for the remaining 20% coinsurance payment after the Part B deductible is met.

Rental or purchase of a Medicare-covered wheelchair

To obtain a Medicare-covered wheelchair, an individual can either rent or purchase the equipment from a Durable Equipment Company (DME) that participates with Medicare. Both options have advantages and disadvantages, but it's crucial to consider several factors to make the best decision.

Renting may suit individuals who need the wheelchair for a short duration, while purchasing may be a cost-effective option for those requiring it for an extended time. Also, consider maintenance and repair costs, as Medicare covers repairs for rented and purchased wheelchairs. Still, individuals may be liable for any negligence-related damages. Ultimately, the individual should base their decision to rent or buy on their needs and financial position.

How much will a wheelchair cost with Medicare?

Medicare typically covers 80% of the Medicare approved cost of a wheelchair, and the individual is responsible for the remaining 20% of the coinsurance payment after the Part B deductible is met. The cost of a wheelchair with Medicare can vary, depending on various factors, such as the type of wheelchair, the individual's needs, and their plan. If the patient chooses ancillary options or a more advanced model, they will be responsible for paying additional fees.

Check with Medicare or the individual's plan to determine the coverage and costs for a wheelchair. Medicare Advantage plans, for instance, may have different coverage options and costs for wheelchairs than Original Medicare. Some plans may offer additional benefits or lower prices for certain wheelchairs. The individual can contact their plan or Medicare to obtain specific information about their coverage and costs

How Medicare covers the cost of a wheelchair

To obtain coverage for a wheelchair from Medicare, it must be medically necessary and prescribed by a healthcare provider. The individual must have a medical condition that impairs their mobility, and the wheelchair is required to improve their ability to move around. It is important to obtain a prescription and ensure that the wheelchair meets Medicare's criteria.

Medicare usually covers 80% of the Medicare approved cost of the wheelchair, with the individual responsible for the remaining 20% coinsurance payment after the Part B deductible is met. However, certain types of wheelchairs may have limited coverage and cost, and the individual may need to pay out of pocket for a more expensive or non-covered model. Additional features or a more advanced model may also require extra payment.

It is essential to contact Medicare or the individual's plan for specific coverage and cost information. Choose a reputable supplier who accepts Medicare to ensure the claim is processed correctly and prevent unexpected out-of-pocket expenses.

Tips for getting Medicare coverage for a wheelchair

Make certain the wheelchair and options remain within Medicare-approved specifications for approval to prevent additional out-of-pocket costs.

To ensure Medicare covers a wheelchair, it is crucial to obtain a prescription from a healthcare provider and verify that the wheelchair meets Medicare's coverage criteria. This includes confirming the wheelchair is medically necessary and is from a Medicare-approved supplier.

Medicare will cover the cost of one mobility device, such as a wheelchair or a scooter, every five years. So, it's important to choose the right option for the individual's needs to ensure they have access to the mobility assistance they need for a prolonged period.