Does Medicare Pay for Wheelchairs?

Wheelchairs, whether powered or manual, are covered by Medicare Part B as durable medical equipment (DME). You need a documented order from your doctor specifying that you must use the wheelchair at home due to your medical condition. For use outside the home, a wheelchair is not covered by Medicare.

Learn about the several Medicare coverage options that cover wheelchairs, how to obtain Medicare to cover them, and the associated expenses.

Does Medicare Pay for Wheelchairs?

When your doctor or another healthcare professional determines that a wheelchair is necessary for treating your medical condition at home, Medicare Part B pays for them. In this situation, a long-term care facility would be considered to be your home instead of a nursing home or hospital offering Medicare-covered care.

If you’re a member of a Medicare Advantage plan, you don’t need to be concerned because the plan is obligated to cover the same medically necessary services and supplies as Original Medicare Parts A and B (Original Medicare) do. To find out if your insurance will cover the wheelchair, you must first contact the main medical practitioner covered by your plan.

Renting vs. Buying

If your DME provider is enrolled in Medicare, they will be fully aware of whether Medicare allows you to purchase the DME or pays for you to rent it. Only inexpensive or often purchased equipment, such as walkers, blood sugar monitors, or sophisticated rehabilitative power wheelchairs, are typically purchased by Medicare, which normally pays for the majority of durable medical equipment on a rental basis.

Renting a Wheelchair

Medicare pays a monthly fee when you rent a wheelchair to use the device. Depending on the type of equipment, these monthly payments may last for a different amount of time. For often purchased or inexpensive equipment, the total rental payments cannot be greater than the price Medicare sets for its purchase.

When you’re finished using it or if it needs repairs, your provider will come to get the item. The provider must also pay any expenses to repair or replace parts of the rented equipment.

Buying a Wheelchair

When you purchase a wheelchair, you become the sole owner of the device, and Medicare may also pay for any necessary repairs or part replacements. Except in cases where your supplier refuses to accept the Medicare-approved amount, you will only be responsible for 20% of the approved cost while Medicare pays the remaining 80%.

How To Get Medicare To Pay for Your Wheelchair

If a licensed medical professional prescribes a wheelchair for use at home and verifies the wheelchair’s medical necessity in accordance with the coverage rules, Medicare Part B will pay for the wheelchair. Here is the procedure in action.

Get a Prescription

The wheelchair must first be prescribed to you by your doctor, who should be a Medicare participant. This will need to be examined in order to learn more about the medical condition that necessitates the use of your wheelchair and how to diagnose, treat, and manage it. Your doctor must record this examination and provide details about your present and past history of mobility needs, the results of your physical exam, and details to support the medical need at home.

Await Submission of a Standard Written Order (SWO)

The medical professional who conducts your assessment should draft a standard written order (SWO) to prove that the wheelchair is a necessary medical item. Before delivering the device, this is forwarded to a supplier that has received approval from Medicare.

Get Approval

On your behalf, your DME provider will send a prior authorization request and the required paperwork to Medicare. After reviewing the data, Medicare will either give a provisional affirmation (approval) or a non-affirmation (no approval). Claims are denied if they are not approved before being delivered.

Paying for the Wheelchair

If Medicare approves your wheelchair request, you will first need to fulfill your yearly Part B deductible before paying 20% of the Medicare-approved sum. If your supplier has not consented to the assignment for Medicare-covered services, you should prepare to pay more.

How To Appeal a Denial of Coverage

The same supplies and services covered by Medicare Parts A and B must also be covered by Medicare Advantage Plans. You can challenge the coverage refusal and request an impartial review if your Medicare plan won’t pay for the wheelchair you require.

Wheelchairs and other DMEs are subject to the same appeals procedures as other Medicare-covered services. When it comes to Original Medicare, the appeal process begins with the Medicare Administrative Contractor, a commercial health insurer with the legal authority to handle medical or durable medical equipment claims under Original Medicare. The appeals procedure in Medicare Advantage begins with the plan administrator.

What Costs You Need To Cover

Even if Medicare agrees to cover the cost of your wheelchair, you still have expenses to cover. You must first satisfy your Part B deductible for that year, as is customary with all health insurance, and then pay 20% of the Medicare-approved sum. This permitted amount often won’t go over the actual charge or cost that Medicare establishes for the item.

For the most part, Medicare will cover the most essential equipment. You will be required to sign an Advance Beneficiary Notice (ABN) before getting the item if you require upgrades or additional features but your supplier believes Medicare won’t fund them. You must tick the box on this waiver form that states you want the upgrades and are prepared to pay for them in full if Medicare declines coverage.

The Bottom Line

Wheelchairs and associated DME supplies are significant Medicare-covered services that help people accomplish daily living tasks and speed up their recovery from hospitalization. The methods for obtaining DMEs may differ depending on whether you are registered in Original Medicare or Medicare Advantage, even if the guidelines for what is covered should be the same.

Wheelchair costs with Original Medicare and a Medicare Advantage Plan sometimes vary. If you use your wheelchair at home, Medicare Part B will pay for it. Your wheelchair is covered by Medicare Part A, which is intended to cover short-term home health care, hospice care, inpatient hospital care, and short-term skilled nursing care if you’re a patient in a hospital or in a skilled nursing facility (SNF) nursing facility care.

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