Does Medicare Cover Wheelchairs?

Last Updated: 17.09.19

 

If you’ve been injured, suffered a surgery, or your mobility has been compromised and you now have a disability that calls for the use of a compact folding wheelchair or some other similar in-home medical equipment, you can rest assured that your Medicare insurance covers a portion of the cost of such systems.

Although it does not cover the power wheelchairs required for use outside the home, it does offer a few wheelchair benefits. If that’s your case and you don’t know what to do to get the wheelchair you need to move around through Medicare, read today’s post to learn more about the steps you should take to enjoy such benefits.

Medicare plans

The first thing you need to do is to get on Medicare. If you are a U.S. citizen over 65 and you have paid into Social Security for 10 years, you can enroll in one of the four Medicare plans. When applying for Social Security benefits, you will be automatically enrolled in Medicare Parts A and B.

Part A includes hospital care coverage whereas Part B will cover medical supplies and services, which is also the plan you should focus on if you’re in need of a wheelchair. It covers manual wheelchairs and scooters that a doctor prescribes for home use. Therefore, only wheelchairs that are designed for indoor use will be covered through Medicare insurance.

You will have to pay only 20 percent of the Medicare-approved amount of a wheelchair as the deductible applies for the rest of it, that is 80 percent. To enjoy this benefit, though, you must pay the Part B deductible which is now $185 per year (as of 2019).

Visit the official Medicare website or ask for a professional’s help if you need additional information. Your final costs may vary depending on other insurance you may have, the wheelchair supplier, and so on.

There are different ways in which Medicare pays for durable medical equipment (DME) and that depends on whether you want to buy or rent the equipment yet we will cover that below. Also, to enjoy the Medicare wheelchair coverage, your wheelchair supplier and doctor should be enrolled in Medicare.

 

Getting the Certificate of Necessity

If you’re enrolled in Medicare and you’ve made sure that your doctor is enrolled as well, you will have to see your doctor for a signed Certificate of Necessity. Let him/her know about your condition and detail your inability to accomplish daily tasks when not using a wheelchair.

Ensure that a wheelchair is the piece of equipment most appropriate for your health condition and not a walker or a cane. If you can’t operate the wheelchair properly and safely, you might consider finding a professional nurse or a family member to help you with that.

Determine the type of wheelchair that best suits your needs. Wheelchairs are generally divided into three types: manual wheelchairs, power wheelchairs, and power-operated vehicles or scooters.

Manual wheelchairs will require you or someone else to push the chair. If you have enough strength to maneuver it or you have an assistant to help you with that, you might qualify for this type. To get a scooter, though, you will have to demonstrate that you can sit up, get in and out of the scooter safely, whether with or without help, and use the controls properly.

In case your mobility is greatly limited and none of these types would help you, you might need and qualify for a power wheelchair. In such cases, you will have a face-to-face examination in order for your doctor to submit the written prescription.

Wheelchair costs

As we’ve said before, even if you’re enrolled in Medicare and you meet the deductible, you will still need to cover 20 percent of the wheelchair cost. In case you don’t have the possibility to pay the 20 percent, try the Medicare Savings Program for additional assistance. Depending on the state you live in, the amount of money you receive if you qualify may vary.

When seeing your doctor to get examined, try to determine wheelchair use time. This will help you decide whether to rent or buy a wheelchair. Renting one will cost you less in the short term yet buying one is a better idea if you need to use it for a long time. The medical supplier will give you more details regarding the payment options.

Make sure you opt for a supplier that is approved by Medicare. The official Medicare website includes a supplier directory where you can find information on approved suppliers. Moreover, you might get the equipment you need at a lower price through the Competitive Bidding Program.

In certain states, Medicare-approved suppliers submit bids and thus offer you the possibility to pay even less for the needed equipment. However, you need to be enrolled in Part A and Part B, also known as the Original Medicare plan. In case you’re enrolled in Part C, you may not have access to such a program, therefore, call Medicare directly and ask for the needed information.

Once you have the signed Certificate of Necessity and you have decided on a supplier and the wheelchair type, you can call the supplier. Make sure you do so within 45 days, though. The company should send a representative before delivering the equipment you want to buy in order to measure your house and make sure the model you’ve ordered is the right one.

If the initially ordered wheelchair does fit your place and needs, the supplier will make the required payment and delivery arrangements. In case the wheelchair type you want does not fit the way your house is designed and the space you have at disposal, the company should recommend you a more appropriate model.

If you are not eligible for Medicare coverage and assistance regarding such equipment, it is still more affordable to rent a wheelchair than to buy one. However, this depends on your personal condition, financial possibilities, and other such aspects.

 

 

 

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RICHARD K LAING
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RICHARD K LAING

How often will Medicare pay for a wheel chair (ex: 1 every 5 years, other)?

Can I request both a manual and powered chair?

Thank you.

madeline West
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madeline West

I need a small adult wheel chair for my 92 year ol mom