Medicare & Electric Wheelchairs: Who Pays?

Imagine a world where moving around your own home is a daily challenge. Many people face this reality every day, struggling to navigate their living space due to mobility issues. Their independence was at stake until they discovered the potential of getting an electric wheelchair covered by Medicare. This opened a new realm of possibilities, reinstating their freedom and ease of movement within their home.

Understanding the intricacies of Medicare coverage can be complex, especially when it comes to understanding the specifics of Durable Medical Equipment (DME) like wheelchairs. This article aims to demystify how Medicare assists with the costs associated with different types of wheelchairs, including manual, power-operated vehicles (scooters), and power wheelchairs.

Overview of Medicare Coverage for Wheelchairs

Medicare Part B plays a crucial role in covering wheelchairs, but there are specific criteria to meet. Your doctor must submit a written order to Medicare, often referred to as a Certificate of Necessity, stating your medical need for a wheelchair or scooter for home use.

Key requirements include having limited mobility due to a health condition that significantly hampers movement within your home, being unable to perform daily activities even with the aid of canes, crutches, or walkers, and the ability to safely operate the device (or have constant assistance for its use).

Also, both your treating doctor and the equipment supplier must accept Medicare, and an in-home assessment must confirm the practicality of using the equipment in your home environment.

Medicare covers these types of wheelchairs:

• Manual Wheelchairs. These are suitable if you can't use a cane or walker safely but have enough upper body strength or assistance to propel the wheelchair.
• Power Scooters. Designed like motor scooters, they are an option if you lack the strength to operate manual wheelchairs or use canes/walkers. You must be able to safely enter and exit the scooter and operate its controls.
• Power Wheelchairs. Consisting of a seat, armrests with controls, and an electric motor, power wheelchairs are for those who can't use manual options or don't qualify for scooters. A face-to-face exam with your doctor is mandatory before receiving a power wheelchair.

How to Get a Wheelchair from Medicare

Getting a wheelchair with the help of Medicare involves several steps:

1. Schedule a doctor's appointment for a mobility assessment.
2. Discuss your mobility challenges and the necessity for a wheelchair.
3. Ensure you can operate a wheelchair safely.
4. Decide on the type of wheelchair needed, which your doctor must include in the Medicare Certificate of Necessity.
5. Have your doctor sign the Certificate of Necessity.
6. Confirm your Part B deductible has been met ($226 in 2023).
7. Decide whether to rent or buy the wheelchair, based on the duration of need.
8. Choose a Medicare-approved supplier.
9. Contact the supplier within 45 days of getting your Certificate of Necessity for a home consultation.

Medicare's Financial Contribution

After meeting your Part B deductible, Medicare pays 80% of the approved amount for the wheelchair, with the remaining 20% being your responsibility.

If you feel a power wheelchair or scooter would best meet your mobility needs, it's important to have a detailed discussion with your doctor. If they determine that it's medically necessary, they should provide an order or prescription following a face-to-face consultation. The order must detail your mobility issues, the inability to perform daily activities, the impracticality of manual options, and the necessity of the wheelchair for a specific medical condition or injury for home use. Remember, this meeting should occur no more than 45 days before the prescription is written.

Also, remember Medicare covers only one piece of equipment for at-home mobility issues. Your doctor will decide whether you need a power wheelchair, scooter, or a different mobility aid based on your specific condition.

Upon receiving the doctor's order or prescription, ensure you approach a supplier approved by Original Medicare or your Medicare Advantage Plan to qualify for coverage.

Discount Ramps Supports Your Mobility Needs

Understanding Medicare's coverage for electric wheelchairs is vital for ensuring you receive the support and equipment necessary to enhance your mobility and quality of life. In addition to Medicare, there are other resources available to make your home and life more accessible. For instance, Discount Ramps offers a wide array of mobility devices, from outdoor ramps to bath safety products, catering to a variety of needs. We're committed to assisting in improving accessibility in every aspect of life, ensuring that you have the necessary tools and resources to navigate your environment comfortably and safely.