Call to speak to a Licensed Insurance Agent
There are many types of equipment today that can help with mobility issues. Wheelchairs are helpful for those who are unable to walk for reasons like temporary leg injuries or long-term paralysis.
So a common question many people have is, “does Medicare cover wheelchairs?” In this article, we answer that question in clear, plain English. You will also find the average costs of wheelchairs and other helpful info.
Does Medicare Cover Wheelchairs?
The short answer is yes; Medicare will cover the cost of 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 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 wheelchairs. Coverage for wheelchairs is provided by Medicare Part B. Wheelchairs are considered as Durable Medical Equipment, or DME, which Medicare Part B covers. You can either rent or purchase a wheelchair and have Medicare Part B cover it.
Medicare Part B will provide coverage for your wheelchair if your primary care physician or healthcare provider writes an order stating the following:
- Your medical condition limits your mobility, thus preventing you from taking care of your daily needs
- You are capable of operating the wheelchair safely
For Medicare Part B to cover the purchase or rental of your wheelchair, both your healthcare provider and your DME provider must be Medicare-enrolled.
Coverage for Different Types of Wheelchairs
Medicare Part B covers three types of wheelchairs and each has a requirement before they cover the DME.
Manual wheelchairs are the easiest to get covered by Medicare. Simply follow the requirements above. You may still be eligible for a manual wheelchair even if you do not have enough upper body strength to operate it. In that case you must be accompanied by a person who can safely operate and get you in and out of the wheelchair.
Medicare Part B may provide coverage for a power scooter if you cannot safely use a manual wheelchair. To get coverage for your power scooter, you will need to visit your healthcare provider to confirm if you can safely get in and out of the power scooter and hold yourself upright while you are operating it.
For power wheelchairs, your healthcare provider also needs to submit an order stating why you need one. In some cases, you may require prior authorization before Medicare Part B provides coverage for your power wheelchair.
You or your DME supplier must submit the required documents to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC). By 10 days, you should receive a decision from the DME MAC. If they decline your request, you or your DME supplier can appeal to that decision as long as you provide documents stating why you need the power wheelchair.
Once approved, Medicare Part B covers 80 percent of the costs of your wheelchair.
Part C Coverage for Wheelchairs
Medicare Advantage plans (Medicare Part C) also provide coverage for wheelchairs. They cover everything Original Medicare covers and typically offer some additional benefits. However, exactly what it covers and your out-of-pocket costs are will vary depending on the specifics of your plan.
How Much Does A Wheelchair Cost?
The average cost of a manual wheelchair is around $500. An electric wheelchair may cost anywhere from $1,000 to $15,000. The average cost for an electric wheelchair is in the $2,000 to $3,000 range.
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 TDaP vaccine?