Does Medicare Pay for Wheelchairs?

Getting Wheelchairs Covered by Medicare

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Medicare Part B helps cover wheelchairs, either manual or powered, as durable medical equipment (DME). Your doctor must submit a written order stating that your medical condition requires you to use the wheelchair at home. Medicare won’t pay for a wheelchair used outside of the home.

Learn what type of Medicare coverage pays for wheelchairs, how to get Medicare to pay, and the costs you’ll need to pay.

Key Takeaways

  • Medicare Part B pays for wheelchairs only when your doctor prescribes them for use in treating your medical condition.
  • Medicare will only cover your durable medical equipment (DME) if both your doctor and supplier are enrolled in Medicare.
  • After meeting your annual Part B deductible, you’re only required to pay 20% of the Medicare-approved amount for the wheelchair. Medicare pays the remaining 80%.
  • If you’re denied coverage for a wheelchair you believe you need, you may appeal the decision and get an independent review.

Does Medicare Pay for Wheelchairs?

Medicare Part B pays for wheelchairs when your doctor or other health care provider deems it a necessity for treating your medical condition at home. In this case, a nursing home or hospital providing Medicare-covered care won’t qualify as your home, but a long-term care facility would. 

You must have a face-to-face examination, which can be in person or via telehealth, and have a written prescription from your health care provider before Medicare will consider wheelchair coverage.

There’s no need to worry if you’re enrolled in a Medicare Advantage plan, because the plan is required to pay for the same medically necessary services and equipment as Medicare Parts A and B (Original Medicare) do. However, you must first call your plan’s primary care provider to find out whether your plan will provide the wheelchair. 

Renting vs. Buying

If your DME supplier is enrolled in Medicare, they’ll know outright if Medicare lets you buy or pays for you to rent a specific DME. Medicare typically pays for most durable medical equipment on a rental basis, and only buys inexpensive or routinely bought equipment such as walkers, blood sugar monitors, or complex rehabilitative power wheelchairs.

Renting a Wheelchair

When you rent a wheelchair, Medicare makes monthly payments for using the equipment. The length of these monthly payments will vary depending on the type of equipment. The total rental payments for routinely bought or inexpensive equipment can’t exceed the fee Medicare sets to buy them.

Medicare often pays to rent more-expensive equipment, like wheelchairs, for 13 months of continuous use, after which time, ownership of the equipment must be transferred to you.

Your supplier will collect the item when you’re done using it or if it needs repairs. The supplier must also cover any costs to repair or replace parts of the rented equipment.

Buying a Wheelchair

Buying a wheelchair will give you full ownership of the item, and Medicare may also cover the cost to repair or replace parts. You will only pay 20% of the approved cost, while Medicare pays 80%, except when your supplier doesn’t accept the Medicare-approved amount. 

Medicare may replace your equipment if it’s stolen, lost, totaled, or used beyond its reasonable useful lifetime, usually five years from when you start using it.

How To Get Medicare To Pay for Your Wheelchair

Medicare Part B pays for your wheelchair if a qualified practitioner prescribes it for use in your home and documents the medical necessity as per the coverage requirements. Here’s how the process works. 

Get a Prescription

Your physician, who should be enrolled in Medicare, must first prescribe the wheelchair to you. This will require an examination to help gather information about diagnosing, treating, and managing the medical condition that makes your wheelchair a necessity. Your doctor must document this exam and include information about your present and past history of mobility needs, the results of their physical exam, and details to support the medical need at home. 

Await Submission of a Standard Written Order (SWO)

The practitioner who performs your examination should prepare a standard written order (SWO), which documents that the wheelchair is a medical necessity. This is sent to a Medicare-approved supplier before it can deliver the equipment. 

Only the practitioner who performs the in-person examination can write the SWO, which they must submit within six months after the examination.

Get Approval

Your DME supplier will submit a prior authorization request and all the necessary documentation to Medicare on your behalf. Medicare will review the information and issue either a provisional affirmation (approval) or non-affirmation (no approval). Failing to get approval before the item is delivered results in denial of a claim.  

Medicare may deny your prior authorization request if it either discovers you don’t medically require a wheelchair or doesn’t get sufficient information to make a decision.

Paying for the Wheelchair

If Medicare gives the OK for your wheelchair, you’ll need to meet your annual Part B deductible, then pay 20% of the Medicare-approved amount. You can expect to pay more if your supplier has not accepted assignment for Medicare-covered services. 

How To Appeal a Denial of Coverage

Medicare Advantage Plans must pay for the same medically necessary equipment and services as Medicare Part A and B. If your Medicare plan won’t pay for a wheelchair you believe you need, you may appeal the denial of coverage and get an independent review of your request. 

The appeal process for wheelchairs and other DMEs is the same as for other Medicare-covered services. In Original Medicare, the appeal starts with the Medicare Administrative Contractor—a private health insurer with the geographic jurisdiction to process Original Medicare medical claims or Durable Medical Equipment claims. In Medicare Advantage, the appeal process starts with the plan administrator.

If you’re denied coverage, you should receive a denial letter that provides information on deadlines to appeal and the process to follow.

What Costs You Need To Cover

If Medicare approves coverage of your wheelchair, you still have a financial obligation to meet. Customary with any health insurance, you must meet your Part B deductible for that year, then cover 20% of the Medicare-approved amount. Usually, this approved amount won’t exceed the actual charge or fee Medicare sets for the item. 

Medicare will generally pay for the most basic level of equipment needed. If you need upgrades or extra features and your supplier thinks Medicare won’t cover them, you’ll need to sign an Advance Beneficiary Notice (ABN) before receiving the item. On this waiver form, you must check the box stating you wish the upgrades and will agree to cover their full cost if Medicare denies coverage.

You may have to cover the full cost of your wheelchair if you get it from a supplier that isn’t a contract supplier.

The Bottom Line

Wheelchairs and related DME supplies are important services covered by Medicare that enable individuals to complete activities of daily living and facilitate their recovery after a hospital stay. Although the rules for which items are covered should be the same, the avenues for accessing DMEs may depend on whether you’re enrolled in Original Medicare or Medicare Advantage.

The amount you pay for wheelchairs with Original Medicare and a Medicare Advantage Plan often differs. Medicare Part B will cover your wheelchair if you use it in your home. If you’re a hospital inpatient or in a skilled nursing facility (SNF), your wheelchair is covered under Medicare Part A, which is designed to cover short-term home health care, hospice care, inpatient care in hospitals, and short-term skilled nursing facility care.

Frequently Asked Questions

What brands of electric wheelchairs does Medicare cover?

Here is a list of 40 types of power wheelchairs covered by Medicare.

How do you sign up for Medicare?

You can sign up for Medicare in any of these three ways:

  • Online at SocialSecurity.gov
  • Calling Social Security at 1-800-772-1213 (TTY users may call 1-800-325-0778)
  • In person at your local Social Security office

How much does Medicare cost?

Unless you’re enrolled in premium-free Medicare Part A, you’ll pay a monthly premium for your coverage and a portion of the costs each time you receive a covered service. The 2022 standard premium rate is $499 per month, and $274 per month if you paid Medicare taxes for 30-39 quarters. The standard Part B premium is $170.10. Premiums for Part C and D vary by plan.

What is the Medicare deductible for 2022?

In a benefit period, a $1,556 Medicare Part A deductible applies each time you’re admitted to a hospital. For Part B, you’ll pay a $233 deductible once each year, beginning in 2022. The deductible amount for Parts C and D varies based by plan.