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I’m 72 and retired. I’ve relied on a wheelchair for a few years now. Recently, I’ve been curious about getting an electric or motorized wheelchair, but I’m unsure if Medicare will cover that. Or if it could cover a wheelchair upgrade?
I’m curious, does Medicare cover wheelchairs?
Wanting a speedy wheelchair,
James from Naples, Florida
Great question. I’m sure many people are wondering the same thing. Nearly 1.9 million people aged 65 and older use a wheelchair, whether it’s manual, powered, or a motorized scooter. I’m sure some of them would like to upgrade.
I’ll do my best to answer your question and provide a path forward for what you’re hoping to get covered by Medicare.
First, yes, Original Medicare Part B covers the cost of wheelchairs, considered Durable Medical Equipment (DME). However, there are requirements for coverage and costs.
To qualify for a wheelchair or power-operated scooter, you must have a face-to-face examination and receive a written prescription from a doctor or other treating provider. The provider must declare that it’s medically necessary. Only then will Medicare cover a manual wheelchair, power wheelchair, or scooter.
“To ensure you’re not hit with a surprise medical bill, ensure that your doctor and wheelchair provider are both accepted by Medicare.“
To be deemed medically necessary, you must have limited mobility and meet all of these conditions (and possibly more depending on the wheelchair or scooter):
If you meet these qualifications, then your wheelchair, power wheelchair, or scooter could be covered by Medicare Part B. There is, however, a cost.
The average manual wheelchair costs between $100 and $800. The average cost of a power wheelchair is $7,135, and the range for a motorized scooter is $600 and $4,000. These are high-cost items.
After you pay your Medicare Part B deductible, you’ll pay 20% of the Medicare-approved amount for your wheelchair or scooter. Medicare will cover the remaining 80%.
This means that you could potentially pay between $20 and $160 for a manual wheelchair, $1,427 for a power wheelchair, and between $160 and $800 for a motorized scooter. This is without a Medicare Supplement or Medicare Advantage plan.
A Medicare Supplement plan could help you with these out-of-pocket costs. Because Original Medicare doesn’t have a cap, expenses can add up fast. These wheelchair expenses are just an example. But a Medicare Supplement plan could help with some or all of the 20% coinsurance costs.
Medicare Advantage plans must provide the same coverage and care as Original Medicare. This means that Durable Medical Equipment (DME), in this case, wheelchairs, are covered by Medicare Advantage plans. These plans may provide greater coverage, so you should check with your plan or explore Medicare Advantage plans and their wheelchair coverage limits.
To ensure you’re not hit with a surprise medical bill, ensure that your doctor and wheelchair provider are both accepted by Medicare. Also, get prior authorization for your purchase to protect yourself from financial hardship.
I hope that this answers your question. And provides you the confidence to request the wheelchair upgrade you want.
Need help reviewing Medicare Supplement or Medicare Advantage plans that will cover these costs?
A local licensed Connie Health agent can review your plan options and ensure you pay as little as possible for the necessary benefits and coverage—call (623) 223-8884 to speak with an agent in your community.
The short answer is yes, but specific criteria must be met. For Medicare to cover an electric wheelchair, the user must have a medical need. This means that the user must have a condition that makes it challenging to move around. Additionally, the user must have a prescription from a doctor stating that an electric wheelchair is necessary for their mobility. Furthermore, the user must meet the specific criteria set forth by Medicare.
One of the main criteria for Medicare coverage of an electric wheelchair is that the user must be unable to operate a manual wheelchair. This means the user must not have the upper body strength or dexterity required to move around in a manual wheelchair. Additionally, the user must be able to operate an electric wheelchair safely. This means that the user must have the cognitive ability to control the wheelchair and be able to perceive environmental obstacles.
For manual wheelchairs, Medicare covers the cost of the chair with a few caveats. First, the wheelchair must be deemed “medically necessary,” meaning it must be required due to a medical condition. Additionally, the beneficiary must be able to operate the chair safely and effectively. This means that seniors who are unable to use a manual chair due to physical limitations may not be eligible for coverage.
For power wheelchairs, Medicare coverage is more complex and dependent on the individual. Generally, power wheelchairs are covered when they are medically necessary, and the beneficiary cannot use a manual wheelchair. Additionally, the beneficiary must have a face-to-face examination and a written prescription from a healthcare professional. It’s also essential to note that power wheelchairs are typically more expensive than manual ones, and the individual may be required to pay a 20% co-payment.
Finally, it’s important to remember that Medicare only covers durable medical equipment (DME) considered medically necessary. This means that certain types of wheelchairs, such as those designed for sports or recreational purposes, may not be covered. If you’re unsure whether a particular wheelchair qualifies for coverage, it’s best to speak with your healthcare provider or a a local licensed Connie Health agent.
There are several factors to consider when determining if Medicare covers a wheelchair for a senior citizen. One of the most important factors is the type of Medicare coverage you have, whether it is Original Medicare or a Medicare Advantage plan. Original Medicare will typically cover 80% of the cost of a basic manual wheelchair if it is deemed medically necessary by a doctor. However, if you have a Medicare Advantage Plan, additional benefits may include more coverage for durable medical equipment like wheelchairs.
Another factor to consider is the type of wheelchair you need. There are different types of wheelchairs available, such as manual wheelchairs, power wheelchairs, and motorized scooters. While Original Medicare typically covers manual wheelchairs, power wheelchairs, and motorized scooters may require additional coverage or cost-sharing on the part of the patient. Your doctor can help you determine the type of wheelchair you need and whether or not your Medicare plan covers it.
Read more by William Revuelta
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.