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Durable medical equipment (DME) is medical equipment that is designed to assist you in carrying out your regular activities. Walkers, wheelchairs, and oxygen tanks are included in this category of medical equipment.
For wheelchairs, there are a few different types. Some are manual where it has to be pushed to move. Others are power wheelchairs that have motors and can move using a control.
If you or a loved one needs a power wheelchair, a common question you likely have is, “Does Medicare cover power wheelchairs?” In this article, we answer the question in clear, plain English.
You will also find the average costs of power wheelchairs if you have to pay for one out of pocket.
Does Medicare Cover Power Wheelchairs?
The short answer is yes; Medicare will cover the cost of power wheelchairs. But not 100% of the time. As is often the case with Medicare, you will have to meet certain conditions in order for Medicare to pay for your power wheelchairs. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for power wheelchairs. This plan includes coverage for your power wheelchairs if considered medically necessary.
Medicare Part B Coverage of Power Wheelchairs
Coverage for power wheelchairs is provided by Medicare Part B. Medicare Part B considers power wheelchairs as Durable Medical Equipment or DME.
Medicare Part B provides coverage for the rental or purchase of power wheelchairs, similar to providing coverage for hospital beds. However, as earlier stated, for Part B to provide coverage, it has to be medically necessary to treat certain medical conditions.
When Does Part B Consider Power Wheelchairs Medically Necessary?
For Medicare Part B to consider the rental or purchase of power wheelchairs to be medically necessary, it has to follow these specific conditions:
- You have a medical condition limiting your mobility, and a power wheelchair can help you manage your condition.
- Your condition makes it difficult for you to move around in your home, even with a walker or cane.
- Using a manual wheelchair or scooter safely is hard or impossible, but you can operate a power wheelchair or scooter.
- It is difficult for you to perform daily activities in your home without the DME.
- You had a face-to-face evaluation with your healthcare provider, and they prescribed it. The meeting should occur no more than 45 days before the prescription is written.
For Medicare Part B to provide coverage for your power wheelchair, your DME supplier must request a prior authorization.
Once approved, Medicare Part B covers 80 percent of the costs of a power wheelchair. You will pay for the remaining 20 percent.
Medicare Advantage Coverage of Power Wheelchairs
Next, Medicare Advantage plans (Medicare Part C) also provide coverage for power wheelchairs. This is because all Advantage plans have to cover the same equipment, services, etc. that Original Medicare covers.
These plans will also cover things Original Medicare does not. What each plan covers and how much the out-of-pocket costs are will vary based on the plan’s specifics.
How Much Do Power Wheelchairs Cost?
If you have to pay for a power wheelchair out of pocket, the costs will range from around $1,500 to $4,000 on average. A higher-end power wheelchair may cost as high as $15,000.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always 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 Telepsychiatry?