One great benefit of using an electric wheelchair is that people who have limited upper body strength can still maneuver the medical equipment without requiring much assistance or labor. However, electric wheelchairs are expensive compared to a manual wheelchair, and not everyone who needs them can easily afford them.
So a common question many people have is, “does Medicare cover electric wheelchairs?” In this article, we answer that question in clear, plain English. You will also find the average costs of electric wheelchairs and other helpful info.
Does Medicare Cover Electric Wheelchairs?
The short answer is yes; Medicare will cover the cost of electric wheelchairs. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your electric wheelchair. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for electric wheelchairs. Coverage for electric wheelchairs is provided by Medicare Part B. Electric wheelchairs classify as Durable Medical Equipment, or DME. Medicare Part B provides coverage for medically necessary DME such as an electric wheelchair.
For Medicare Part B to provide coverage for your electric wheelchair, these conditions have to be followed:
- Your primary care physician or your healthcare provider writes an order
- You have a medical condition that limits your mobility, thus preventing you from taking care of your daily needs
- You are capable of operating the wheelchair safely
- Your healthcare provider is enrolled in Medicare
- Your DME supplier is enrolled in Medicare
Medicare Part B will only provide coverage for an electric wheelchair if you cannot safely maneuver and use a manual wheelchair.
In some cases, you may need prior authorization before Medicare Part B provides coverage for your electric wheelchair. The required prior authorization needs to come with an order from your healthcare provider along with documents provided by your DME supplier.
You or your DME supplier must submit the documents stated above to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC). Within 10 days, you should receive a decision from the DME MAC. If the DME MAC declines your request, you or your DME supplier can appeal that decision if you can provide the documents that state why you need the electric wheelchair.
Once approved, Medicare Part B covers 80 percent of the costs of your electric wheelchair.
Part C Coverage for Electric Wheelchairs
Medicare Advantage plans (Medicare Part C) also provide coverage for electric wheelchairs. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and your out-of-pocket costs will vary depending on the specifics of your plan.
How Much Does An Electric Wheelchair Cost?
An electric wheelchair may cost anywhere from $1,000 to $15,000. The average electric wheelchair costs between $2,000 to $3,000. Some factors that may affect the cost of an electric wheelchair may include the brand, quality, and features.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover eye exams for cataracts?