Medicare provides health insurance coverage for a range of medical needs seniors may have. While doctor's visits, preventive care, lab tests or even surgery are what primarily come to mind when you think of Medicare coverage, it also covers what's known as "durable medical equipment," which includes scooters, wheelchairs and walkers.
Medicare uses specific criteria to determine whether it will cover the costs of these mobility devices. If you or your loved one needs a wheelchair, here's what you need to know about Medicare wheelchair coverage.
Does Medicare Cover the Cost of Wheelchairs?
Yes, Medicare covers wheelchairs as part of its Part B coverage. Medicare Part B, or the medical insurance portion of Medicare, covers both medically necessary and preventive services and supplies.
Medicare Part B will cover wheelchairs and other durable medical equipment under certain conditions. First, your doctor must submit an order that states you have a medical need for a wheelchair at home. You also must meet the following five criteria:
You must have a health condition that significantly affects your mobility in your home.
You can't do regular daily activities, such as bathing, dressing or walking, even with the help of a cane, crutch or walker.
You can safely operate and get on or off a wheelchair.
Your doctor and the wheelchair supplier are both enrolled in Medicare.
You're able to use the wheelchair in your home (e.g., it easily fits through doorways)
Under Medicare, you can either rent or buy a wheelchair. In most cases, Medicare will pay for a manual wheelchair if you can't use a cane or walker safely but have enough upper body strength or assistance from someone at home who can help you get in or out of the wheelchair.
Medicare will pay for a power wheelchair if you can't use a manual wheelchair or if you don't meet the requirements for a power scooter, which include being able to operate the equipment safely on your own.
How to Submit a Wheelchair Request to Medicare
Whether you'll need a manual or power wheelchair, you'll have to undergo an in-person exam with your doctor first. After an assessment, they will decide which device meets your medical needs and submit a written order to Medicare. If you need a certain type of power wheelchair, you also may have to get prior authorization, which requires your wheelchair supplier to submit the appropriate forms to Medicare along with your doctor's order.
Medicare will review all of this information and decide whether to approve or deny your request. If your request is approved, you'll likely have to pay coinsurance, or 20% of the Medicare-approved amount after you pay your annual Part B deductible. For 2021 the yearly deductible is $203. Medicare will pay the remaining 80% of the cost for your wheelchair.
If your request requires prior authorization and is denied, call 1-800-MEDICARE (1-800-633-4227) to make sure Medicare has received all of the necessary information from your doctor and supplier to make an eligibility determination. If not, ask both of them to resubmit the necessary documents. If Medicare denies your request for a wheelchair because they don't deem it medically necessary, you may be able to qualify for a wheelchair through Medicaid, the federal health insurance program for low-income Americans.
Organizations like The American Red Cross, Goodwill and the Salvation Army may have donated wheelchairs you can purchase for an affordable price. You could also reach out to the department of senior services in your community to ask if they maintain a list or can refer you to local and national organizations that provide low-cost or free wheelchairs.
If you have private health insurance in addition to Medicare, consider contacting your insurer to see if coverage for a wheelchair is one of your benefits. If so, you may only have to pay coinsurance.
Medicare and Mobility
As you get older, a wheelchair can be an important tool for maintaining your mobility, safety and a certain degree of independence, especially if you plan to age in place. If you need a wheelchair, talk to your doctor about submitting a request, and make sure both your provider and wheelchair supplier are enrolled in Medicare.
If they are and you have a medical need for a wheelchair, Medicare should approve the request so you can get the medical equipment you need thanks to Medicare wheelchair coverage.