- Renting or purchasing a wheelchair may be covered by Medicare in some cases.
- You must meet Medicare’s standards.
- Make sure your doctor and the wheelchair provider are both Medicare-approved.
If a medical condition keeps you from moving around your home, a wheelchair could be a solution to your mobility problems. Once you fulfil these conditions, Medicare Part B will cover a variety of wheelchairs.
When does Medicare cover wheelchairs?
If your primary care physician(PCP) or a specialist treating you for a disease that affects your mobility prescribes one, Medicare Part B will cover most of the cost.
- A medical condition prevents you from taking care of your daily needs, per your doctor’s order. Additionally, even with crutches, walkers, or canes, your medical condition prevents you from reaching the restroom or the kitchen.
- It is safe to use the equipment you requested, or you can have someone in your home who can assist you whenever you need it.
- Medicare should approve both the supplier and your doctor. To see if the device is Medicare-approved, check with your doctor and the company that provides it.
- The gadget is safe to use at home because of uneven flooring, obstacles in your path, and entrances that are too tight for your wheelchair.
What kind of wheelchair does Medicare cover?
Regulations for obtaining a wheelchair may alter temporarily if wheelchair regulations change.
Medicare will cover the following wheelchairs:
Wheelchairs are long-term medical equipment (DME). Basic wheelchairs include manual wheelchairs, power scooters, and power wheelchairs.
The type of wheelchair funded by Medicare is determined by your physical condition and your doctor’s advice.
If you can get into and out of a manual wheelchair, this one may suit you.
Even if you have the upper-body strength to handle a manual wheelchair, you may need help getting into and out of it, as well as using it securely. If your mobility limitations are only temporary, renting the equipment rather than purchasing it may be more cost-effective.
HIGH POWER SCOOTERS
For manual wheelchairs, Medicare will cover the cost of a power scooter. In-person consultation with your doctor is required to make sure you are physically capable of using a power scooter and can remain upright while driving one.
An in-person evaluation is necessary before they issue you with a power wheelchair. After your examination, your doctor will sign an order stating that you can safely use a motorized wheelchair and why you require one.
Before you can purchase or rent a power wheelchair, you must first get permission from Medicare. Your medical equipment provider should supply you with all the paperwork required.
The Medicare Administrative Contractor for Durable Medical Equipment accepts submissions from you or your medical equipment supplier (MAC, DME). The MAC of DME should respond to your application with a determination.
You have the right to appeal if your Medicare claim is denied. The item/device/manufacturer tools can provide you with specific information about why you require them in your home.
Does Medicare cover patient lift?
If your doctor thinks you’ll require a lift, Medicare Part B will cover 80% of the cost of the lift. You are responsible for the remaining 80% of the cost.
A lift is classified as “durable medical equipment” by Medicare (DME).
An additional ramp for wheelchairs?
A wheelchair ramp is considered durable medical equipment under Medicare Part B, although it is not reimbursed due to the cost. You will have to pay for a wheelchair ramp yourself if you want one installed.
With Medicare, what are the copayments for wheelchairs?
When your annual deductible is met, Medicare Part B covers 80% of the cost of a wheelchair. However, you’ll have to pay an extra 20% of your Medicare premium each year. To acquire your wheelchair, you’ll need to schedule an appointment with your doctor.
DME suppliers are required to bid competitively in various regions, which helps to keep costs down. Until January 1, 2021, the competitive bidding program has been halted.
During the time of transition, The importance of aggressive marketing methods used by DME providers grows even more. To learn more about a DME supplier or someone who has tried to sell you DME, please call the HHS Office of Inspector General’s Fraud Hotline at 1-800-447-8477 or use the online reporting tool.
To ensure wheelchair availability, which Medicare plans do you choose?
You’ll need to select a Medicare plan to be eligible for Medicare.
Medicare Part A:
If you are admitted to a hospital or a nursing home, Medicare Part A covers your hospital and nursing home bills.
Medicare Part B:
It provides coverage for wheelchairs.
Medicare Advantage Part C:
Wheelchairs are covered by Medicare Advantage plans as mandated by original Medicare (parts A and B). Benefits and criteria will vary between plans.
Medicare Part D:
Medicare Part D provides prescription drug coverage, but you do not need a prescription or a doctor’s order to receive a wheelchair.
Medigap policies are supplement plans that cover expenses that Medicare does not cover, so that some Medigap policies may cover the cost of a wheelchair.
Will Medicare cover additional mobility aids?
Medicare Part B pays about 80% of the cost of walkers, rollators, crutches, and canes (after your deductible has been paid), while the remaining 20% of the expense is on you. A doctor’s order is mandatory for stating that the mobility equipment is medically necessary.
The Bottom line
If you have a health problem that prevents you from meeting your daily needs, Medicare Part B will reimburse you for 80% of the cost. You are responsible for 20% of the remaining fee, as well as your deductible, premium payments, and any applicable copayments.
Medicare covers manual wheelchairs, power scooters, and power wheelchairs. It is important to confirm if your doctor and medical equipment supplier qualify for Medicare before buying a wheelchair.
If you are using a wheelchair, your doctor may have to state why you need it, and your equipment supplier will have to provide extra documents.