Does Medicare Cover Wheelchair Costs

By Maurice

Wheelchairs and other mobility aids are life-altering devices. They can help you get around while you’re recovering from an injury or if you require permanent assistance when it comes to getting around. However, one of the biggest challenges that you can face is trying to figure out if Medicare covers the cost of a wheelchair.

Medicare might cover the cost of your wheelchair, but it’s going to depend on a few specifics. Medicare covers powered wheelchairs, scooters, and manual wheelchairs, but they need to be prescribed by your doctor as well as sold by an official Medicaid retailer.

There’s a lot more that goes into figuring out if Medicare will cover the cost of your wheelchair. We’re going to cover everything you need to know in this article.

Does Medicare Cover Your Wheelchair?

The official policy is that Medicare covers the costs of a wheelchair, but only under specific conditions.

Medicare covers the cost of wheelchairs based on Medicare Part B which handles outpatient insurance coverage. Let’s take a closer look at the rules, regulations, and requirements you’ll need to meet in order for Medicare to cover the cost of your wheelchair or other mobility aid.

The first thing you need is a prescription from your doctor that is treating the condition which causes you to need a wheelchair. This prescription cannot come from a different position. You also need to meet a few other criteria.

You have a health condition that severely limits your mobility
This prevents you from doing daily activities like getting out of bed, using the bathroom, or getting around your home
You are still able to safely operate a wheelchair
Your doctor requires that you use a wheelchair or scooter
Your doctor or Medicare supplier has visited your home and determined that a wheelchair can be used in your building
A cane, crutch, or walker is not a suitable alternative

What is Durable Medical Equipment

DME

Medicare requires that your wheelchair count as Durable Medical Equipment before it can be covered.

Durable Medical Equipment is designed to be used long-term, in the home, and is essential to the treatment of your condition. Certain types of wheelchairs, scooters, and mobility aids do not meet the Medicare criteria for DME and can not be covered.

However, many brands of wheelchairs, scooters, and other devices do meet these criteria and can be covered.

Will Medicare Cover a Replacement Wheelchair?

Medicare will cover the cost of a replacement wheelchair if it is totally destroyed by accident or was stolen. You will need documented proof of this destruction or theft in order to have Medicare cover the cost of a replacement.

Medicare will also cover the cost of a damaged wheelchair. Medicare only covers repairs up two the cost of a replacement.

Medicare also requires that you purchased our wheelchair at least 5 years ago. Your wheelchair can not be any older than the expected lifespan of your device.

For example: If your wheelchair is expected to last 10 years, you must have had this wheelchair for at least 5 years, but no more than 10 to have Medicare cover your repairs.

What Types of Wheelchairs are Covered by Medicare?

There are a few different types of wheelchair that Medicare covers. Let’s take a look at each one.

Manual Wheelchairs

Manual wheelchairs are powered by upper body strength or with the help of an assistant. If you have enough strength, or help, with your wheelchair, you could qualify for this type of mobility aid.

Scooters

If you do not have help or if you also do not have the ability to move a wheelchair on your own, you might be eligible for a scooter.

These are powered devices that require you to sit upright and operate controls.

Powered Wheelchairs

Powered wheelchairs are a distinct device from powered scooters. They have back support which makes controlling these devices much easier.

You need to have a face-to-face exam with your doctor before you can qualify for any of these devices.

Rentals

The last category of device are rentals. If you are expected to recover from your condition in the near-term future, you might be required to rent, rather than buy, your mobility aid.

How to Buy a Wheelchair With Medicare?

There is a straightforward process when it comes to buying a wheelchair with Medicare.

After you have paid your Medicare Part B deductible, you will only need to pay 20% of the cost of your wheelchair. Medicare will cover the other 80% of the cost of your wheelchair.

Your cost may be different if you have supplementary or private medical insurance. Costs can also be affected by being required to rent a wheelchair rather than purchase one.

Both your doctor who prescribes the mobility aid and the retailer that is selling the mobility aid need to be approved by Medicare. Only Medicare approved sellers can be covered by Medicare.

What if Medicare Doesn’t Cover My Wheelchair?

You have a handful of options to get an affordable wheelchair if Medicare does not offer you any coverage.

The first thing you should do is check your local medical equipment bank as well as disability advocacy groups. These organizations often have resources in place to help individuals get free or affordable wheelchairs, scooters, or powered wheelchairs.

You can also try shopping on Craigslist or eBay. These are online resale shops that often have affordable pricing for gently used durable medical equipment.

If you are eligible for Medicare, make sure you work with a Medicare approved physician. This will make it much easier, and much more likely, that you will be able to get prescribed the mobility aids that you require to live your life.

Wrapping Medicare and Wheelchair

Medicare covers the cost of wheelchairs as long as they are prescribed by your physician and sold by a Medicare approved retailer.

You will also need to meet a few specific requirements in order to be eligible for a wheelchair from Medicare. These include being severely limited in terms of mobility by your illness, requiring a wheelchair for day-to-day life, and not being able to otherwise use a cane or walker.

Even if you can’t get a wheelchair through Medicare, you have other options such as shopping on online stores or at your local resale shop.