Older adults can experience limited mobility to perform daily living activities (such as bathing and getting dressed).
This can warrant the need for a wheelchair. However, not everyone can comfortably carry the out-of-pocket costs of even a manual wheelchair.
After all, a wheelchair can cost a hundred to several thousand dollars, depending on its features and manufacturer.
Fortunately, wheelchairs are covered by original Medicare and Medicare Advantage — although you’ll need to meet certain conditions.
In this article, we’ll discuss the requirements and the process of getting a Medicare-deductible wheelchair.
Does Medicare Pay for Wheelchairs?
Yes, Medicare Part B would be the best option for paying for wheelchairs for the elderly.
Part B is medical insurance, which covers the following:
- Services from healthcare providers
- Outpatient care
- Home health care
- Durable medical equipment (DME)
- Preventative screenings
Wheelchairs fall under DMEs.
Eligibility Requirements
For your wheelchair to be Medicare-approved, you’ll need to meet the following requirements:
- Your medical condition causes you to have mobility issues, making it hard to move around your home.
- A cane, crutch, or walker isn’t enough to help you move around.
- You (or someone you’re always with at home) can safely operate the wheelchair.
- Both the doctor and medical equipment supplier are authorized Medicare providers.
- Your doctor or supplier has visited your home to verify that the durable medical equipment is reasonable for use.
However, these guidelines can temporarily change if the U.S. President, your state governor, or the Department of Health and Human Services declares an emergency in your area.
Types of Wheelchairs Covered
Aside from assessing the patient and their home, another big part of being eligible to be Part B-deductible is to know the types of wheelchairs it covers.
Medicare benefits cover the following wheelchairs:
Manual Wheelchairs
If you have enough upper body strength to operate a manual wheelchair, then this can be a good choice.
Alternatively, you can still get manual wheelchairs if you have someone at home who can help you use it.
Power Scooters
If you don’t have the upper body strength required for safely operating a manual wheelchair, then a power-operated scooter is great.
However, the doctor should first confirm that you’re strong enough to get in and out of the power scooter on your own. You should also be able to hold yourself upright while driving it.
Power Wheelchairs
Power wheelchairs, or electric wheelchairs, are for those who can’t sit up in a power scooter.
To qualify for a power wheelchair, your doctor must examine you and write an order saying you can use a power wheelchair and why you need it.
Some kinds of power wheelchairs require a “prior authorization request” — meaning Medicare needs to approve the device first before you can buy or rent it.
To do this, you or your medical equipment supplier must submit the requirements to the Durable Medical Equipment Administrative Contractor (DME MAC).If your request gets denied, you can appeal the decision by explaining in more detail why the electric wheelchair is needed at home.
Costs Associated With Wheelchair Coverage
It would be best if you understood how much Medicare will cover and how much you’ll still need to pay out of your own pocket.
Deductibles and Copays
How much Medicare will cover depends on things like whether or not you’ve met your annual deductible.
Medicare Part B generally pays for 80% of a wheelchair’s cost once your Part B deductible is paid for the year.
Of course, you also have copay costs for any doctor’s visits to get the wheelchair.
Competitive Bidding Program
In some cities, DME suppliers have to join a competitive bidding program. Here, you’ll have to get your manual or power wheelchair from an approved supplier.
Wheelchairs sold under this program are already relatively cheaper, so the portion you’ll need to pay lowers too.
How to Get Medicare to Pay for Your Wheelchair
Here is a quick step-by-step on how to get Medicare wheelchair coverage:
Get a Written Order From Your Doctor
Your primary care physician should state that you have a medical need for a wheelchair due to limited mobility.
Some medical conditions the doctor could state are:
- Musculoskeletal disorders
- Neurological disorders
- Spinal injuries with paralysis
IMPORTANT NOTE: Ensure that your doctor is covered by Medicare. Otherwise, the wheelchair won’t be covered despite being considered durable medical equipment.
Request Prior Authorization
Request prior authorization from a DME supplier that’s under Medicare. Then, you can send that to Medicare for approval.
Get Approval for Your Wheelchair
You’ll typically get Medicare’s decision around 10 days after submitting the written order and prior authorization.
You can contact Medicare if you have questions regarding the decision or haven’t received a letter yet.
File an Appeal
Medicare can deny your request for two reasons:
- They don’t think a wheelchair is medically necessary
- They didn’t receive enough information to think you need it.
Fortunately, you can still file an appeal. Simply follow these steps:
- File the appeal by the date listed in your Medicare Summary Notice.
- There are two ways to file your appeal through the company that handles your Medicare claims:
- Fill out the “Redetermination Request Form.”
- Send a written request.
- Have the following in your claim:
- Name, address, and Medicare number
- The decision you’re appealing and why you’re appealing it (here, you can justify more why a lightweight wheelchair or electric wheelchair is medically necessary, for instance)
- Name of appointed representative (if applicable)
Other Resources
Aside from original Medicare, you can look for other resources to help you pay for a wheelchair — regardless of your health condition.
Additional Insurance Options
You might have private insurance through a family, work, or buying from an insurance company.
Health plans usually send Evidence of Coverage (EOC) every year. This document details your plan’s benefits — such as what’s covered and how it works.
Other Mobility Programs
Some organizations donate wheelchairs and other mobility aids to those who need them. These organizations include:
- American Mobility Outreach
- Kansas Equipment Exchange
- LifeNets – The Wheelchair Project
- Wheelchair Recycling Project
Medicare Advantage Plans
You’re also eligible for Medicare Advantage or Medigap plans if you’re enrolled in Medicare.
These plans are offered by private insurance companies and can fill in the gaps of original Medicare.
If you have Medigap (a Medicare supplement plan), it will likely cover the remaining 20% that Medicare doesn’t pay for.
Meanwhile, a Medicare Advantage plan has the same benefits as Medicare Part B and Part A. The requirements and specific benefits will differ depending on your plan.
Frequently Asked Questions
As you can see, the Medicare program does help pay for wheelchairs.
To help you understand the process and requirements more, below are some frequently asked questions:
Can I Choose Whether I Buy or Rent a Wheelchair?
Generally, you might end up renting a wheelchair.
That’s because Medicare coverage typically only buys relatively inexpensive equipment — like canes and walkers. For more expensive products (like wheelchairs), it defaults to renting.
However, if you’ve been renting for 13 months, it will switch from a rental to a purchase.
Does Medicare Cover Home Modifications?
No, home modifications aren’t under original Medicare coverage.
However, Medicaid services may be able to give you funds for home modifications such as:
- Wheelchair ramps
- Doorway widening
- Chair lifts/stairlifts
As such, you should first ask your primary care provider what home modifications can apply to make using electric wheelchairs easier to use in the home.
This increases the chance of the DME being Medicare-approved.
Does Medicare Pay For Other Mobility Aids?
Yes, similar to wheelchairs, other mobility aids can be Medicare-deductible. These aids include:
- Walkers
- Rollators
- Crutches
- Canes
The process is the same — the doctor believes a piece of medical equipment is medically necessary. You should also find a DME supplier that will accept Medicare.
If approved by Medicare, Part B pays 80% of it.
Does Medicare Cover Knee Scooters?
No, neither original Medicare nor Medicare Supplement plans cover knee scooters since they’re not considered medically necessary.
However, some Medicare Advantage plan beneficiaries might be able to avail knee scooters.
That’s because plans and benefits vary per state. So, if you’re covered by a Medicare Advantage plan, review the benefits to know whether you’ll need to pay for knee scooters.
What’s the Difference Between Electric Wheelchairs and Power Scooters?
An electric wheelchair is most commonly used indoors. Because of that, it’s able to navigate tight spaces.
Meanwhile, a power scooter is mostly used outdoors — though it can also be used indoors. However, it’s quite difficult to turn in tight spaces.
Similar to manual wheelchairs, it requires some upper body strength too.
Are There Other Medicare Plans For Getting a Wheelchair?
It would be best to be familiar with the different Medicare plans so you can receive coverage accordingly:
- Medicare Part A – Since this covers hospitalization, the hospital or nursing home you’re staying in will be the one to provide a wheelchair.
- Medicare Part B – This covers medical services. This is most likely where your wheelchair will be covered as durable medical equipment.
- Medicare Part C – Also known as Medicare Advantage, this covers the same things as Medicare Parts A and B. Wheelchairs are covered here — although specific requirements and benefits will vary according to your plan.
- Medicare Part D – This is prescription drug coverage. Yes, a doctor prescribes the wheelchair, but this plan won’t cover that.
Medigap plans – These are Medicare supplement plans that can help you pay for additional costs not covered by Medicare.
Conclusion
Wheelchairs are covered by both original Medicare and Medicare Advantage plans.
However, the best Medicare plan would be Plan B.
For a Plan B-deductible wheelchair, a doctor submits an order detailing that the patient has mobility issues that will require the use of a wheelchair.
Remember that the doctor and wheelchair supplier must be enrolled in Medicare.
You can also utilize Medicare supplement and Advantage plans. You can also participate in a competitive bidding program.
If you can’t get a Medicare-approved wheelchair, some organizations can help you get one too.
