If you have Medicare and you are one of the millions of people that require a wheelchair to get around, you might be wondering if Medicare will pay for an electric wheelchair or a mobility scooter? The answer is yes, but there are limits and conditions.
In this MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. article, we’ll explain how Medicare covers durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds. for mobility and what you and your doctor need to do to get coverage.
- Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. will cover electric wheelchairs if they are approved by your doctor.
- Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. will cover the cost of wheelchairs and other mobility aids as part of your skilled nursing care.
- Medicare will not cover the cost of a wheelchair ramp for your home unless you can prove it is medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice..
- The average cost for an electric wheelchair before coverage is about $1,500 and $4,000.
- Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). will cover electric wheelchairs, but you may be restricted to in-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... suppliers.
- MedigapMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. plans can help with the out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. for electric wheelchairs after Medicare covers its share.
How Does Medicare Cover Electric Wheelchairs?
Medicare Part B covers power-operated mobility aids, such as battery-powered scooters and wheelchairs, as durable medical equipment (DME). Medicare pays 80 percent of your DME if:1Medicare.gov, “Medicare’s Wheelchair & Scooter Benefit“, Accessed December 1, 2021
- Your doctor submits a written order stating that you need a wheelchair or scooter for use in your home due to one or more medical conditions.
- You have limited mobility and:
- Have a health condition that causes significant difficulty moving around in your home.
- You can’t perform activities of daily living (bathing, dressing, getting in or out of a bed or chair, or using the bathroom) even with a cane, crutch, or walker.
- You can safely use the wheelchair or scooter or have someone with you who is available to assist you.
- Your doctor and wheelchair or scooter supplier are both enrolled in Medicare.
- You can operate the equipment in your home (e.g., it fits through doorways and is not blocked by floor surfaces, etc).
When approved, you will pay 20 percent of the Medicare-approved amountA Medicare-approved amount is what Medicare will pay for a covered service. Healthcare providers that agree to Medicare assignment accept the approved amount without excess charges. What Does Medicare-Approved Amount Mean? A Medicare-approved amount is.... The Part B deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. also applies.1Medicare.gov, “Medicare’s Wheelchair & Scooter Benefit“, Accessed December 1, 2021
Medicare Part A will also provide coverage for an electric wheelchair or other DME for mobility during the first 100 days of your care at a skilled nursing facility. Once your doctor has determined you need a wheelchair as part of your treatment, the skilled nursing facility will provide it.2Medicare.gov, “Medicare Coverage of Durable Medical Equipment & Other Devices“, Accessed December 1, 2021
Will Medicare Cover A Wheelchair Ramp for My Home?
No, Medicare will not normally cover the costs of a wheelchair ramp because they are not strictly medically necessary. Consult with your doctor about your condition. If they are able to confirm that a wheelchair ramp is medically necessary for your condition, Medicare can reimburse you for the cost of the ramp installation.3payingforseniorcare.com, “Paying for Wheelchair Ramps: Medicare’s Benefits & Costs“, Accessed December 30, 2021
However, if you are a MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. beneficiaryA person who has health care insurance through the Medicare or Medicaid programs., your state may include Medicaid Waivers that can cover the cost of a wheelchair ramp. You can look at your state’s Medicaid Waivers and what they provide here.3payingforseniorcare.com, “Paying for Wheelchair Ramps: Medicare’s Benefits & Costs“, Accessed December 30, 2021
How Much Does An Electric Wheelchair Cost?
The average cost for an electric wheelchair can vary between $1,500 and $4,000 without coverage. If you require additional medical equipment attached to the wheelchair, this cost can reach up to $15,000. If you have Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., you will likely be paying $300 to $800 in Part B out-of-pocket costs for an average electric wheelchair after Medicare pays its share.4Silvercross.com, “Power Wheelchairs“, Accessed December 1, 2021 If you have Medicare supplement insurance for additional coverage, your supplement will pay its share of your Part B out-of-pocket costs.6Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed December 1, 2021
Do Medicare Advantage Plans Cover Electric Wheelchairs?
Since Medicare Advantage plans must cover the same services the Medicare Part A and Part B cover, Medicare Advantage plans will cover electric wheelchairs when medically necessary. However, your Medicare Advantage plan provider may require you to use services, facilities, and supplies within their network, meaning you may not be able to get the exact electric wheelchair you desire. Your out-of-pocket costs with a Medicare Advantage plan may also differ from Medicare Part A and Part B for those same covered services and supplies.5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 1, 2021
If you’re in need of a motorized wheelchair or any other device to help you move around safely, Medicare will cover its share of the costs. All you have to do is talk with your doctor and they can help you get started. If you need help finding a Medicare-approved durable medical equipment provider in your area, you can search Medicare’s DME supplier directory here.
- 1Medicare.gov, “Medicare’s Wheelchair & Scooter Benefit“, Accessed December 1, 2021
- 2Medicare.gov, “Medicare Coverage of Durable Medical Equipment & Other Devices“, Accessed December 1, 2021
- 3payingforseniorcare.com, “Paying for Wheelchair Ramps: Medicare’s Benefits & Costs“, Accessed December 30, 2021
- 4Silvercross.com, “Power Wheelchairs“, Accessed December 1, 2021
- 6Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed December 1, 2021
- 5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 1, 2021