Will Medicare Pay for a Wheelchair?
Summary: Medicare generally covers wheelchairs at 80%. For help paying the remaining 20%, you may want a Medicare Supplement insurance plan.
You may hope you never end up in a wheelchair, but people with temporary or permanent mobility issues may benefit from a wheelchair. Doctors commonly prescribe wheelchairs for people with
- neurological disorders,
- musculoskeletal disorders,
- broken bones, or
- spinal injuries with paralysis.
If you’re covered by Medicare and your doctor prescribes a wheelchair, here’s what you should know about your coverage.
Does Medicare cover wheelchairs?
Part B typically covers allowable charges for a wheelchair under certain conditions as durable medical equipment (DME). Your doctor writes an order confirming the wheelchair is medically necessary because you have limited mobility, and you meet all of the following requirements:
- Your condition makes it difficult for you to move about your home.
- Even with a cane or walker, you’re unable to manage daily activities of living such as bathing and using the bathroom.
- You can operate the wheelchair and get in and out of it on your own or with the help of someone who lives with you.
- The wheelchair fits through your doors and hallways at home.
- Both the doctor prescribing the wheelchair and the medical supplier providing it, are enrolled in Medicare.
What types of wheelchairs are covered by Medicare?
There are three main types of wheelchairs: Standard manual wheelchairs, power scooters, and electric wheelchairs. If you have enough upper body strength to safely manage a manual wheelchair, or have someone at home who can push you, your doctor might order a manual wheelchair.
If you lack upper body strength to operate a manual wheelchair, but are able to sit up on your own, a power scooter may be more appropriate. If you aren’t able to sit in a power scooter, your doctor may order an electric wheelchair.
Your doctor must certify that one of the above wheelchair types are medically necessary to manage your condition. Then Medicare will typically cover 80% of the charges after you meet your deductible.
Note, however, that your doctor must have a face-to-face evaluation with you to determine medical necessity and your ability to operate the device before Medicare will pay for either a power scooter or electric wheelchair.
You generally have the option to rent or purchase a wheelchair; if your mobility issue is temporary, you may be better off renting your wheelchair or scooter. Your DME supplier can advise you which wheelchairs and scooters are available for rent under Medicare.
Are wheelchairs under Medicare’s competitive bidding program?
The Medicare program implemented a cost-saving measure known as the competitive bidding program which applies to certain types of durable medical equipment. Wheelchairs, along with items such as hospital beds and bedside commodes, are included in the program.
If you live in certain areas of the country covered by the competitive bidding program, you will need to get your wheelchair from an approved supplier. If you don’t, Medicare may refuse to cover any costs associated with your wheelchair or power scooter.
Note that the competitive bidding program was temporarily suspended on December 31, 2018, and is not expected to be reinstated until January 2021.
Where do I get an electric wheelchair covered by Medicare?
As noted previously, in order to qualify for Medicare coverage, both the doctor prescribing your electric wheelchair and your medical device supplier must be enrolled in Medicare. Your health care provider should be able to refer you to a participating DME supplier in your area. You can also contact Medicare directly at 1-800-MEDICARE to find participating DME suppliers near you.
Note that Medicare requires prior authorization for certain types of electric wheelchairs before it will pay your rental or purchase costs. If your doctor orders a power scooter or certain models of electric wheelchairs, either you or your DME supplier needs to send documentation from your doctor about your need for an electric wheelchair or power scooter along with a request for authorization before you rent or purchase your chair.
Medicare will review the request, and if you meet all the requirements, you and the supplier will be notified that your electric wheelchair is covered. Be cautious about signing any rental or purchase agreement with your supplier before you have Medicare approval, or you could end up paying all the costs out of your own pocket.
How can I get more help paying for a wheelchair?
You might be concerned about the 20% coinsurance you generally have for a wheelchair under Medicare Part B. If you have power wheelchair that is worth $4,000 or more you might be responsible for nearly $1,000 in coinsurance. That’s where Medicare Supplement insurance plans from private insurance companies come in. Medicare Supplement insurance plans cover various copayments, coinsurance, and deductibles not covered by Original Medicare. You typically have options for Medicare Supplement coverage, and all plans cover at least 50% of the Medicare Part B coinsurance. So if you were responsible for $1,000, you may only be responsible for $500 with Medicare Supplement coverage. Some Medicare Supplement insurance plans cover 100% of the Medicare Part B coinsurance cost. You may pay an additional premium to have a Medicare Supplement insurance plan.
To find a Medicare Advantage plan that also covers wheelchairs or a Medicare Supplement plan that helps you cover the out-of-pocket costs for a wheelchair, enter your ZIP code on this page.