If an illness has limited your mobility, a wheelchair can mean the difference between independence and assisted living, especially if you need help performing activities of daily living, such as bathing and dressing. If you are eligible for Medicare because you are 65 years of age or older, or have a disability and receive Social Security benefits for more than 24 months, the cost of renting or buying a wheelchair may be covered by Part B.
Medicare Part B, also known as medical insurance, covers durable medical equipment (DME). DME must be prescribed by a doctor for use in the home and have an expected lifetime of at least 3 years. Manual wheelchairs and power-operated vehicles are covered under this benefit as long as you meet specific criteria. Wheelchairs are covered only when they are deemed medically necessary.
Types of Wheelchairs
Depending on your specific needs, you may qualify for a manual wheelchair, power-operated scooter, or power wheelchair. If a cane or walker is no longer effective, a manual wheelchair may be appropriate, as long as you have enough upper body strength or someone to assist you. If you can’t operate a manual wheelchair, you may qualify for a power-operated vehicle. You must be able to get in and out of the scooter by yourself, and safely manage the controls. A power wheelchair may be available and covered by Medicare if you have a face-to-face visit with a physician who writes a prescription for the equipment.
How much will you pay for your wheelchair?
If you have Original Medicare, you will likely pay 20% of the Medicare-approved amount of the wheelchair after you have paid your Part B deductible. Medicare Advantage plans are required to provide at least the same benefits as Part A and Part B, but many offer additional coverage. If you are enrolled in a Medicare Advantage plan, contact your plan directly for your exact costs.
Starting on September 1, 2018, you may have to get prior approval (known as “prior authorization”) for certain types of power wheelchairs. Under this program, 33 types of power wheelchairs require “prior authorization” before Medicare will pay for them. If your physician prescribes one of these wheelchairs, your DME supplier will usually submit a prior authorization request and all documentation to Medicare on your behalf. Medicare will review the information to make sure that you’re eligible and meet all requirements for the power wheelchair.