Does Medicare Pay For Wheelchairs?
Yes, if your doctor prescribes a wheelchair or power-operated vehicle (e.g., a scooter) for use at home. In that case, Medicare Part B (medical insurance) will cover wheelchairs as durable medical equipment (DME). However, specific guidelines are needed to receive coverage for these items.
For Medicare to cover a power wheelchair or scooter, you need an in-person examination by a doctor or healthcare provider, who will give you a written prescription. Part B of Medicare only covers power wheelchairs if deemed medically necessary.
Coverage Overview for Wheelchairs
To secure coverage for a wheelchair, your doctor must send a Certificate of Necessity to Medicare, indicating that you need a wheelchair or scooter inside your home because of your medical condition.
You must have limited mobility and meet all of these conditions for coverage:
- You experience a health condition that makes it challenging for you to move around your house
- Even with the assistance of a cane, crutch, or walker, you cannot perform basic daily living activities such as bathing, dressing, getting in or out of a bed or chair, or using the bathroom
- You must be able to safely operate the manual wheelchair or scooter, including getting on and off by yourself or having someone available to assist you in using it safely
- Your doctor and the supplier for your wheelchair or scooter must accept Medicare payment
- A doctor or supplier has evaluated the equipment in your home to ensure that it can be used without any issues, such as being too big to fit through doorways or obstructed by items on the floor
What Are the Costs of a Wheelchair?
After you have paid the Part B deductible, you must pay 20% of the Medicare-approved amount for durable medical equipment (DME) as long as the supplier accepts the assignment. It is important to remember that Medicare covers various types of DME differently depending on the equipment type.
- It may be necessary for you to rent the equipment.
- It may be necessary for you to buy the equipment.
- You may have the option to choose between renting or purchasing the equipment.
For Medicare to cover your DME, it is necessary for both your doctors and DME suppliers to be enrolled in Medicare and to meet the required standards. If they are not enrolled, any claims they submit will not be paid by Medicare.
Check if your doctors and suppliers are enrolled with Medicare to ensure you receive the right DME coverage. Before obtaining DME, ask your supplier if they participate in Medicare. If a supplier participates, they must accept the assignment and can only charge you coinsurance and the Part B deductible for the Medicare-approved amount. However, if a supplier doesn’t participate or accept assignments, they are not limited and can charge you any amount.
What Types of Wheelchairs Does Medicare Cover?
Medicare covers a variety of wheelchairs for those who qualify, including manual and powered scooters and powered wheelchairs. Manual wheelchairs are the most common type of wheelchair covered by Medicare. These include standard lightweight wheelchairs and specialized designs such as bariatric, sports, and pediatric models. Powered wheelchairs may also be covered if medically necessary and prescribed by your doctor. This includes standard powered wheelchairs and specialized models like power tilt-in-space, reclining, or standing wheelchairs.
In conclusion, Medicare generally covers the cost of a wheelchair if the person meets specific requirements and conditions. It is essential to check with your Medicare coverage provider for more information about the specifics of your coverage. Additionally, it would help if you discussed with your doctor and Medicare-approved suppliers the different types of wheelchairs, accessories, and modifications available and their associated costs. A wheelchair can significantly improve mobility and independence, and Medicare coverage makes it more accessible for those who need it.
Is pre-approval needed for a wheelchair through Medicare?
Yes, Medicare requires a written prescription from your doctor and a Certificate of Necessity to ensure that the wheelchair meets all the criteria for coverage.
What diagnoses qualify for a wheelchair?
A person must have a health condition that makes it challenging to move around their house, even with a cane, crutch, or walker. Additionally, they must be unable to perform basic daily living activities such as bathing, dressing, getting in or out of bed, or using the bathroom without an assistive device.