how often will medicare pay for a wheelchair

How Often Will Medicare Pay For A Wheelchair

If you have Medicare and have a disability or condition that limits your mobility, you may be eligible for a wheelchair or power-operated scooter. 

You may hope that you never need a wheelchair, but people who have temporary or persistent mobility liAmitations may benefit from one.

Fortunately, if you fulfill the eligibility requirements and a doctor prescribes one, Medicare will cover the cost of a manual or electric wheelchair.

Continue reading to learn more about Medicare’s coverage of wheelchairs and other mobility devices.

How often will Medicare pay for a wheelchair
How often will Medicare pay for a wheelchair?

How to Get Medicare to Cover Your Wheelchair or Scooter

To get started, make an appointment with your primary care physician.

You should explain all of your mobility issues during this face-to-face meeting.

Explain why you believe you require a wheelchair.

Being unable to perform typical day-to-day activities such as:

  • getting out of bed
  • clothing yourself
  • whether or not you can use the bathroom

All of these are valid reasons for getting DME.

It is essential that you properly explain your restrictions to your doctor.

This ensures that you are prescribed the appropriate type of equipment.

What types of wheelchairs are covered by Medicare?

Wheelchairs are classified into three types: standard manual wheelchairs, power scooters, and electric wheelchairs.

If you have enough upper body strength to manage a manual wheelchair safely, or if you have someone at home who can push you, your doctor may order one.

A power scooter may be more appropriate if you lack the upper body strength to operate a manual wheelchair but can sit up on your own.

If you cannot sit on a power scooter, your doctor may recommend an electric wheelchair for you.

However, before Medicare would pay for either a power scooter or an electric wheelchair, your doctor must do an evaluation with you to determine medical necessity and your ability to operate the device.

You can generally rent or buy a wheelchair; if your mobility problem is temporary, you may be better off renting your wheelchair or scooter.

Your supplier will be able to tell you which wheelchairs and scooters are available for rent through Medicare.

If you believe you or someone you care about requires a wheelchair, follow these two steps:

Steps to obtain a Medicare-covered wheelchair

Original Medicare (Part A and B) does cover wheelchairs and walkers, but there are some restrictions and requirements to be aware of.

These goods are classified as “Durable Medical Equipment” (DME) and are covered under Medicare Part B.

Wheelchairs, walkers, and other durable medical equipment are also covered under the Medicare Advantage Plan (Part C).

Some Medicare Advantage plans also cover home adaptations such as wheelchair ramps and grab bars in the bathroom.

Your doctor issues an order stating that the wheelchair is medically essential due to your limited mobility.

1. What you require from your doctor is as follows:

  • The doctor must explain in writing why you require the wheelchair to get around your home and why a walker or cane will not provide you with the mobility you require.
  • You must be unable to operate a manual wheelchair if the doctor prescribes a power wheelchair or scooter.
  • Whether you require a manual or a power wheelchair, the doctor must explain why you need it
  • The doctor must also say that you are capable of using the wheelchair on your own or with the assistance of someone who will accompany you at home.

2. Where can you get a wheelchair?

  • If you have traditional Medicare, the wheelchair must be purchased from a Medicare contract supplier.
  • To find out where to go for your wheelchair, call Medicare at 1-800-633-4227 or go to the website.
  • If you are enrolled in a Medicare HMO or another private Medicare program, contact the plan and follow the guidelines of the program.

Remember that Medicare will not cover a wheelchair if you do not require one for usage in your house, even if you require it to get around outdoors.

However, if you require it for usage in your home, you may use it outside of your home as well.

Your Costs in Original Medicare

If you qualify for a wheelchair or power scooter, you must pay 20% of the permitted charges plus any relevant deductible.

A motor-powered scooter costs between $700 to $2,000 on average, therefore the total cost of the scooter may vary.

In addition, depending on where you live, Medicare‘s competitive bidding program may apply to your equipment.

If you live in an area where this is the case, you must purchase your scooter from a vendor contracted with Medicare through the competitive bidding program.

As a result, the cost may be reduced.

Before selecting a supplier, ensure that both the provider and your doctor are currently enrolled in Medicare.

Then, talk about your payment options and whether you want to buy or rent the wheelchair from the supplier.

Make your choice based on how long you will require the device.

Part B covers only a percentage of the overall cost of your gadget.

That is, you will be responsible for paying 20% of the cost out of pocket.

Our Thoughts

You may be concerned about the standard 20% payment for a wheelchair under Medicare Part B.

If you have a power wheelchair costing $4,000 or more, you may be required to pay over $1,000 in coinsurance.

This is where commercial insurance firms’ Medicare Supplement policies come in.

Medicare Supplement insurance programs pay for copayments, coinsurance, and deductibles that Original Medicare does not cover.

Medicare Supplement coverage is typically available, and all plans cover at least 50% of the Medicare Part B coinsurance.

Some Medicare Supplement insurance plans pay the entire cost of Medicare Part B coinsurance.

A Medicare Supplement insurance plan may require you to pay an additional premium.

Frequently Asked Questions

Does Medicare cover a wheelchair van?

While Medicare will pay for power wheelchairs and scooters, Medicare will not cover personal mobility vehicles in most cases, even when provided with doctor prescription for durable medical equipment (DME) device.

Will Medicare pay for a standing wheelchair?

Frustratingly, Medicare, Medicaid, and private insurance companies often refuse to cover standing wheelchairs.

They may argue that this type of equipment is not medically necessary, too experimental, or a convenience item.

Some people have found ways to get the government to pay for their standing wheelchair.

Do I need to insure my mobility scooter?

You do not need insurance for a mobility scooter or powered wheelchair, although it’s recommended.

Will Medicare pay for bathroom modifications?

Unfortunately, original Medicare typically does not pay for the cost of home modifications.

Finally, in some rare instances, Medicare will pay for bathroom modifications and walk-in tubs.

Can you use a mobility scooter if you are not disabled?

If you aren’t disabled, you can only drive a mobility scooter if you are demonstrating the vehicle before it’s sold, training a disabled user or taking the vehicle to or from maintenance or repair.