Does Medicare Cover a Wheelchair?
As people age, it isn’t uncommon to experience a decline in your mobility. Common conditions like arthritis (which can cause stiff and painful joints), heart disease, low or high blood pressure, diabetic neuropathy, or recovering from an injury or surgery can all lead to balance issues, falls, or a loss of mobility.
If you’ve been experiencing dizziness, problems with balance, or you’re finding it difficult to move or walk, you might be able to gain back or keep some independence and raise your quality of life by using a mobility aid like a walker or wheelchair.
Having sturdy support from a walker while you’re walking on your own, or using a wheelchair to get around instead of being bedridden, can bring you and your family security and peace of mind. If you’re unsteady on your feet, using a wheelchair can help keep you safe from falls and get you mobile again.
There are many different types of wheelchairs available, so it’s easy to find one that meets your needs. From lightweight and foldable to sturdy and dependable, there are many options available. And what’s even better, your Medicare insurance can help you cover a portion of the cost of renting or purchasing a wheelchair if you are eligible for the benefit.
Does Original Medicare cover wheelchairs?
Original Medicare Part B (medical insurance) provides coverage for manual wheelchairs and power-operated scooters and categorizes these devices under the durable medical equipment benefit.
To be eligible for this coverage, a health care provider who accepts Medicare assignment must prescribe it for you after doing a face-to-face examination. She must then certify to Medicare that the wheelchair is medically necessary for your treatment, you will be the only one using it, and you will use it in your home or permanent residence.
How does Original Medicare Part B pay for a wheelchair?
Original Medicare Part B pays for 80 percent of the Medicare-approved amount for your wheelchair. Depending on the type of equipment you get, Medicare pays for durable medical equipment differently. In some instances, you may need to rent the equipment, so Medicare pays its share of the monthly rental fee. If Medicare requires that you purchase the equipment, it pays for its share of the total cost. In other instances, you may have the choice to rent or purchase your equipment.
Whether you rent or purchase your wheelchair you must get it from a durable medical equipment supplier that accepts Medicare assignment to be eligible for the benefit. You are responsible for your coinsurance payment of 20 percent of the cost to rent or purchase the wheelchair after you have met your annual Part B deductible.
If you are receiving Medicare-covered care in a hospital or nursing home, you don’t qualify for the durable medical equipment benefit. This is because these facilities don’t qualify as your home. For this situation, the medical facility is responsible for providing the equipment you need while you’re there – for up to 100 days. On the other hand, if you live in a long-term care facility, this qualifies as your home, and you can get Medicare coverage for durable medical equipment that you rent or purchase to use there.
How does Medicare Advantage cover wheelchairs?
Your Medicare Advantage (Part C) plan must cover the same equipment and supplies under durable medical equipment as Original Medicare Parts A and B do if you meet qualification requirements.
However, your out-of-pocket costs depend on your individual plan, and your plan may require that you get your durable medical equipment from a specific supplier that is listed on your plan’s network of providers.
If you aren’t certain about who you can get your equipment from, you should get details from your provider before you rent or purchase it. Depending on the type of Part C plan you have, you may not get coverage for the equipment if you use a supplier outside the plan’s network.