Does Medicare Pay for Wheelchairs?
Good news: Medicare helps pay for wheelchairs, walkers, and scooters, but per usual, there’s some fine print attached.
Here’s everything you need to know about Medicare’s wheelchair coverage.
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Medicare Wheelchair Coverage
Wheelchairs, scooters, and walkers are all covered under Medicare Part B. Part B has an annual deductible and covers 80% of your durable medical equipment (DME) costs.
This means you will need to reach your deductible and cover 20% of the wheelchair cost. If you have a Medicare Supplement, it will most likely cover the 20% coinsurance, so you only need to meet your deductible.
In 2022, the Medicare Part B deductible is $233.
According to Freedom Motors, a new wheelchair typically costs between $500-$1,500, though manual options can be as low as $100. If you have your eye on a fancier powered wheelchair, your costs could reach as high as $30,000.
Don’t panic, though—Medicare doesn’t usually buy wheelchairs in full. According to Heckman Healthcare, a Durable Medical Equipment supplier here in Decatur, Medicare rents wheelchairs for 13 months. After 13 months, the wheelchair will belong to you.
If you don’t have a Medicare Supplement, a wheelchair will cost you around $10 per month in rental fees. And if you have a Medicare Supplement, once you reach your deductible, you pay nothing.
Wheelchair Costs If You Have a Medicare Supplement
Your costs will vary slightly depending on which type of Medicare Supplement you have.
Our most popular Medicare Supplement plan, Plan G, will cover your wheelchair in full once you reach your Part B deductible, which is $233 in 2022.
For those with a Plan F (no longer available to those who turned 65 on or after January 1, 2020), your supplement will cover your wheelchair in full. Plan F does not have a deductible.
If you have any other Medicare Supplement policy, reach out to us and we will help you understand your expected out-of-pocket costs.
Wheelchair Costs If You Have a Medicare Advantage Plan
Each Medicare Advantage (MA) plan is unique, so your costs for a wheelchair will depend on your plan design.
To offer an example, the Aetna Medicare Value PPO, available in Macon County, covers 80% of the wheelchair costs from in-network suppliers and 65% of the wheelchair costs from out-of-network suppliers. You need to check with your plan to find out which suppliers are in-network.
Keep in mind that every MA plan is different, and you may also have a deductible to meet before the plan pays.
How Do I Get a Wheelchair Through Medicare?
To get a wheelchair through Medicare, you need to get a written order from your doctor stating you have a medical need for a wheelchair in your home.
You also must have limited mobility and meet ALL of the following conditions:
- You have a health condition that causes significant difficulty moving around in your home.
- You’re unable to do activities of daily living (like bathing, dressing, getting in or out of a bed or chair, or using the bathroom) even with the help of a cane, crutch, or walker.
- You’re able to safely operate and get on and off the wheelchair or scooter, or have someone with you who is always available to help you safely use the device.
- Your doctor who is treating you for the condition that requires a wheelchair or scooter and your supplier are both enrolled in Medicare.
- You can use the equipment within your home (for example, it’s not too big to fit through doorways in your home or blocked by floor surfaces or things in its path).
If you can check off all these boxes, Medicare will help cover the cost of your wheelchair.
Types of Wheelchairs Medicare Will Cover
Medicare will cover three types of wheelchairs, though you may have to try a cheaper option before upgrading to a more advanced version.
- Manual wheelchairs: you’ll likely start with a manual wheelchair rental, which is the most cost-effective option.
- Power-operated vehicle/scooter: if you can’t operate a manual wheelchair, Medicare might approve you for a power-operated version.
- Power wheelchair: if you can’t operate a manual wheelchair or a power-operated scooter, you may qualify for a power wheelchair.
Keep in mind that with power wheelchairs, your doctor will probably have to request “prior authorization” from Medicare with an explanation of why you need this type of wheelchair instead of a manual one.
You can see the exact types of wheelchairs that require prior authorization in this Medicare handout.
Thankfully, Medicare does a pretty good job of covering wheelchairs, scooters, and walkers.
And if you have a Medicare Supplement? Rest assured you will have no out-of-pocket costs once you reach your small annual deductible.
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