What Does Medicare Pay Toward the Cost of Wheelchairs?

Medicare Part B will cover most of the cost of your wheelchair if your primary care physician (PCP) or the health care provider treating you for the condition that affects your mobility writes an order for one. Your doctor’s order should make it clear that:

• A medical condition is causing mobility issues that prevent you from taking care of your daily needs. For example, your medical condition keeps you from being able to get to the bathroom or to the kitchen safely, even if you use crutches, a walker, or a cane.

• You are capable of safely operating the type of equipment you’re requesting, or you have someone in your home who is always on hand to help you use the wheelchair when you need it.

• Your doctor and the medical equipment supplier are both authorized Medicare providers. There are lists of providers, and you can ask your doctor and the company providing the equipment to be sure they are authorized by Medicare.

• You can use the device safely in your home without risking injuries or accidents because of uneven floors, obstacles in your path, or doorways too narrow for your wheelchair.

The rules for how to get a wheelchair can change temporarily if the President of the U.S., the Department of Health and Human Services, or your state governor declares an emergency or disaster in your area. To find out if you’re in one of those areas, you can call 1 (800) MEDICARE (800-633-4227). You can also find information at the Federal Emergency Management Agency (FEMA) website or the HHS Public Health Emergency website.

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Wheelchairs are considered durable medical equipment (DME). There are three basic types of wheelchairs: manual wheelchairs, power scooters, and power wheelchairs.

Which type of wheelchair Medicare will cover depends on your physical condition and your doctor’s recommendations.

Manual wheelchairs

If you are strong enough to get into and out of a manual wheelchair and to operate one when you need to, this type of wheelchair might be a good choice for you.

Even if you don’t have the upper body strength to use a manual wheelchair, you might still qualify for one if there is someone at home with you who can help you get in and out of it, and who can help you use it safely.

If your mobility issues are temporary — if, for example, you’ve had knee replacement surgery and you expect to be walking again soon — you may want to consider renting the equipment instead of buying it.

Power scooters

If you can’t safely use a manual wheelchair, Medicare may pay for a power scooter. To qualify for a power scooter, you’ll need to have an in-person visit with your doctor to confirm that you are strong enough to get into and out of one on your own and to hold yourself upright while you’re driving it.

As is true with manual wheelchairs, you may want to decide whether renting is a better option than buying the equipment outright.

5 Steps for Getting a Wheelchair through Medicare

1. See your doctor to get a prescription for a wheelchair.
2. Find out if you’ve met your annual deductible so you’ll know what you can expect to pay for your wheelchair.
3. Contact a Medicare-enrolled DME supplier.
4. Ask your DME supplier to submit a request for prior authorization if one is needed.
5. If your request is denied, work with your doctor and DME supplier to provide the additional information Medicare needs.

Power wheelchairs

To get a power wheelchair, your doctor will need to examine you in person. After your exam, your doctor will need to write an order saying that you’re capable of using a power wheelchair safely and explaining why you need one.

Certain types of power wheelchairs need a “prior authorization” before you can get one. That means you need Medicare’s approval before you can make the purchase or rent the device. A prior authorization request has to be supported by the order from your doctor plus forms provided by your medical equipment supplier.

Either you or your medical equipment supplier can submit the required documents to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC). You should have a decision from the DME MAC around 10 days after you apply.

If Medicare doesn’t approve your purchase, you have the right to appeal that decision. You or your medical equipment provider can explain in more detail why you need the device to function in your home.

To see the 33 types of power scooters and power wheelchairs that need prior authorization, check the current list here.

If your doctor believes you will need a lift to help you get from a bed into your wheelchair, Medicare Part B will cover 80 percent of that expense. You will be responsible for the remaining 20 percent of the cost.

Medicare defines a lift as durable medical equipment (DME).

Even though a wheelchair ramp may be medically necessary, Medicare Part B does not consider a wheelchair ramp durable medical equipment, so the cost of a wheelchair ramp is not covered. If you want to install a wheelchair ramp, you will need to pay for that on your own.

Medicare Part B pays 80 percent of the cost of a wheelchair after you have met your annual deductible. You will pay 20 percent of the cost in addition to your annual Medicare premiums. You may also have copay costs associated with any doctor visits necessary to get your wheelchair.

In some parts of the country, DME suppliers are required to participate in a competitive bidding program, which helps to keep costs manageable. However, that competitive bidding program has been temporarily paused until January 1, 2021.

During this temporary gap, it is especially important to be aware of aggressive marketing techniques practiced by some DME suppliers. If you have any questions or concerns about a DME supplier, or about someone who has come to your home to try to sell you DME, you can call the Fraud Hotline of the HHS Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477) or report it online.

If you think you’re going to need a wheelchair in 2020 and you’re eligible for Medicare, you will need to decide which plan will best meet your needs.

Medicare Part A covers hospitalization. If you need a wheelchair during a hospital stay or while you are in a nursing home, the facility will provide you with one.

Medicare Part B covers medical services. Under Part B, wheelchairs are covered as durable medical equipment.

Medicare Part C is also called Medicare Advantage. Since Medicare Advantage plans are required to cover the same benefits as original Medicare (parts A and B), wheelchairs are covered under these plans. The specific benefits and requirements will vary from plan to plan.

Medicare Part D is prescription drug coverage. Even though you need a prescription or a doctor’s order to obtain a wheelchair, they are not covered under this part of Medicare.

Medigap (Medicare supplements) are add-on plans to help you pay for costs that Medicare does not cover. Some Medigap plans could help you pay for some or all of the expense of a wheelchair.

Medicare Part B pays for 80 percent of the cost of walkers, rollators, crutches, and canes (after your deductible has been paid). You will need to pay the other 20 percent of the cost. Just like with a wheelchair, your doctor will need to write an order saying that the mobility device is medically necessary for you.

If you have a health condition that limits your mobility in your home and keeps you from being able to take care of your daily needs, Medicare Part B will cover 80 percent of the cost. You will be responsible for paying for the remaining 20 percent of the cost, along with your deductible, premium payments, and any related copayments.

Medicare benefits cover manual wheelchairs, power scooters, and power wheelchairs. It’s important to verify that your doctor and your medical equipment supplier are both enrolled in Medicare before you get a wheelchair.

Your health care provider will need to write an order explaining why you need the device, and your medical equipment supplier may have to submit additional forms depending on which type of wheelchair you need.