If you’re thinking of getting a power wheelchair to increase your mobility, you’re not alone.
A power wheelchair can transform your life, but it will cost you money.
That’s why so many first-time wheelchair users are curious: does Medicare cover power wheelchairs?
Continue reading to learn which Medicare plans cover a wheelchair, whether you qualify for coverage, and more.
Who is qualified for the coverage?
Medicare will only cover the cost of a wheelchair if you have difficulty getting around inside your house.
That is, if you just have mobility issues outside of your house, you will not be eligible for wheelchair coverage.
What are the out-of-pocket expenses for wheelchairs?
Medicare Part B will cover 80% of the cost of any wheelchair type.
However, you must first fulfill your Part B deductible.
When does Medicare cover wheelchairs?
If your primary care physician (PCP) or the health care professional treating you for the disease that limits your mobility makes an order for one, Medicare Part B will reimburse the majority of the cost.
Your doctor’s order should say categorically that:
A medical condition is producing mobility concerns that prevent you from attending to your everyday demands.
For example, your medical condition prevents you from securely reaching the restroom or the kitchen, even if you use crutches, a walker, or a cane.
You are capable of securely operating the equipment you are requesting, or you have someone in your house who is always available to assist you in using the wheelchair as needed.
Both your doctor and the medical equipment supplier are Medicare-approved providers.
There are provider lists available, and you can check with your doctor and the firm delivering the equipment to ensure they are Medicare-approved.
You can use the gadget safely at home without fear of injury or accident due to uneven surfaces, obstacles in your path, or entrances that are too narrow for your wheelchair.
What kind of wheelchair will Medicare cover?
Wheelchairs are considered long-lasting medical equipment (DME).
Wheelchairs are classified into three types: manual wheelchair, power scooter, and electric wheelchair.
The type of wheelchair that Medicare will fund is determined on your physical condition and the advice of your doctor.
If you are able to get into and out of a manual wheelchair and operate one when necessary, this type of wheelchair may be a good fit for you.
Even if you lack the upper body strength to use a manual wheelchair, you may still be eligible if you have someone at home who can help you get in and out of it and who can teach you how to use it securely.
If your mobility limitations are only temporary – for example, if you’ve undergone knee replacement surgery and expect to be able to walk again shortly – you might want to explore renting the equipment rather than purchasing it.
If you are unable to use a manual wheelchair safely, Medicare may cover the cost of a motorized scooter.
To be eligible for a power scooter, you must first contact your doctor in person to certify that you are strong enough to get into and out of one on your own and to keep yourself upright while driving it.
As with manual wheelchairs, you should consider whether renting is a better alternative than purchasing the equipment yourself.
Your doctor will need to evaluate you in person before you can acquire a power wheelchair.
Following your examination, your doctor must sign an order stating that you are competent of operating a motorized wheelchair safely and describing why you require one.
Certain models of power chair require “prior authorization” before being obtained.
That means you’ll need Medicare’s clearance before you can buy or rent the equipment.
A prior permission request must be accompanied by a doctor’s order as well as forms issued by your medical equipment supplier.
The essential documentation can be submitted to the Durable Medical Equipment Medicare Administrative Contractor by either you or your medical equipment supplier (DME MAC).
After you apply, you should receive a decision from the DME MAC within 10 days.
You have the opportunity to appeal if Medicare does not approve your purchase.
You or your medical equipment provider can explain why you require the gadget to perform in your house in further detail.
5 Steps for Getting a Wheelchair through Medicare
- See your doctor to get a prescription for a wheelchair.
- Find out if you’ve met your annual deductible so you’ll know what you can expect to pay for your wheelchair.
- Contact a Medicare-enrolled DME supplier.
- Ask your DME supplier to submit a request for prior authorization if one is needed.
- If your request is denied, work with your doctor and DME supplier to provide the additional information Medicare needs.
The remaining 20% of the cost, as well as any deductible, copayment, or premium payments, are the responsibility of the individual.
Before ordering a DME, the individual’s doctor must submit an order outlining why the device is medically essential, and the supplier must complete any additional paperwork as needed.
Furthermore, before obtaining a wheelchair, mobility scooter, or other device, the individual should establish that both their doctor and the DME supplier participate in Medicare Part B.
Frequently Asked Questions
What does Medicare Advantage give you?
Medicare Advantage plans must cover all of the services that original Medicare covers except hospice care.
Many medicare advantage plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.
Most medicare advantage plans include medicare prescription drug coverage (Part D).
How long does it take to get a wheelchair from Medicare?
You should have a decision from the DME mac around 10 days after you apply.
If Medicare doesn’t approve your purchase, you have the right to appeal that decision.
You or your medical equipment provider can explain in more detail why you need the device to function in your home.
How much is a typical Medicare Advantage plan?
According to the centers for Medicare & Medicaid services in 2018, the average Medicare advantage premium was $30 monthly.
Some Medicare advantage premiums may be as low as $0 for certain plans and other plans may have premiums over $100 a month.
What is not included in Medicare?
Medicare does not cover medical exams required when applying for a job, life insurance, superannuation, memberships or government bodies, most dental examinations and treatment, most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry, acupuncture, and psychology services
Does Medicare cover 100 percent of hospital bills?
Medicare Part A is hospital insurance.
You will also have to pay a deductible before Medicare benefits begin.
Medicare will then pay 100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility.
after that, you pay a flat amount up to the maximum number of covered days.