People who require a wheelchair or another mobility device may wonder whether Medicare pays for part or all of the cost.
Wheelchair coverage depends on a few factors, including whether the equipment is medically necessary.
Read on for more information about Medicare coverage for wheelchairs and other mobility devices.
Medicare Part B may cover one piece of durable medical equipment (DME) that addresses in-home mobility issues.
DME is medical equipment that helps people accomplish their day-to-day activities. In addition to wheelchairs and scooters, DME may include:
- portable oxygen equipment
- hospital beds
- prosthetic devices that replace all or part of an internal organ
- prosthetics, such as artificial arms, legs, or eyes
- orthotics, including rigid or semi-rigid leg, arm, back, and neck braces
- medical supplies that a person uses along with their DME
A doctor may determine whether a person needs a manual wheelchair or a different mobility device based on their health status and everyday needs.
Manual wheelchairs and scooters
If a doctor determines that a manual wheelchair or scooter is medically necessary, they may create an order, certificate, or prescription.
The order usually mentions the following:
- The person’s health makes it difficult to move safely around the home, even with the assistance of a walker or cane.
- The person’s health makes it difficult for them to perform activities of daily living, such as dressing and bathing, in their home.
- The person can safely use the manual wheelchair themselves or will always have someone to assist them.
- The manual wheelchair can help with a specific medical condition or injury.
- Whether the person had a face-to-face meeting with the prescribing doctor.
The meeting should occur no more than 6 months before the doctor writes the order.
Once the person has the order, they should take it to a Medicare-approved DME supplier.
Powered wheelchairs and scooters
If a manual wheelchair or scooter is not suitable for a person, they should schedule an appointment with their doctor for an in-person consultation.
If the doctor determines that an electric wheelchair or scooter is medically necessary, they may write an order, certificate, or prescription.
Usually, a doctor must request prior authorization for original Medicare to cover certain types of powered wheelchairs and scooters.
In addition to the requirements of a regular order, the doctor will also state that the person does not have the ability to use a manual wheelchair or other mobility device and, therefore, requires an electric one.
In this case, the in-person meeting with the doctor should occur no more than 45 days before they write the order.
The person’s condition will determine a doctor’s decision on whether they require a powered wheelchair, powered scooter, or other mobility device.
First, a person should make sure that the doctor and the DME supplier are enrolled in Medicare.
Doctors and DME suppliers have to meet strict standards to enroll and continue their enrollment in Medicare. If either one is not a Medicare enrollee, or neither are, Medicare may refuse to pay claims.
It is also vital to ask the DME supplier whether they “participate” in Medicare. If they are a participating supplier, they must accept assignment.
Accepting assignment means that the supplier agrees to accept the Medicare-approved amount as payment for the service or product. They will send the bill to Medicare. As Medicare often pays only 80% of this approved amount for services, the person may be responsible for the remaining 20%.
If the DME supplier is enrolled but not “participating,” they can choose whether to accept assignment.
People can consult a doctor to determine the out-of-pocket cost for a wheelchair or scooter. The amount owed may depend on several factors:
- a person’s other health insurance
- how much the doctor charges
- whether the doctor accepts assignment
- the type of facility
- where a person chooses to buy their DME
Depending on the type of wheelchair and the health condition that makes it medically necessary, a person may need to rent or buy the equipment.