Home Health What Does Medicare Cover When it Comes to Wheelchairs in the U.S.?

What Does Medicare Cover When it Comes to Wheelchairs in the U.S.?

by Francesca Baptiste

Medicare is the federal health care coverage program for U.S. citizens who are over the age of 65 or who have certain disabilities or long-term illnesses. Medicare is run by the federal agency, Centres for Medicare and Medicaid Services (CMS). Be aware that Medicare is different from Medicaid, which provides health insurance to cover individuals with limited incomes. Medicare eligibility is not nased on income, but you may be eligible for both services.

The program itself is funded in part through Social Security contributions during your working years, taxes paid on income, and sometimes through premiums for services which Medicare does not cover, and in part by the federal budget. Make sure that you understand your Medicare package carefully because different packages offer different levels of cover. Original Medicare will allow you to visit almost all doctors and hospitals across the country. 

Medicare Advantage plans are a little more restricted on access to doctors and hospitals but will provide extra benefits such as routine vision and dental checkups, which Original Medicare programs won’t cover. There are two main parts to Medicare: Part A, which covers inpatient hospital care, and Part B, which covers outpatient medical expenses.  Wheelchairs are covered by Part B.

Am I Eligible for Medicare?

If you are a little confused as to whether you’re eligible for Medicare, let me make it really easy for you. As a general rule, you are eligible for Medicare if you are over the age of 65 and you’ve been paying social security benefit for the past ten years. However, if you are under the age of 65, you may still be eligible if you have a disability, or if you have End Stage Renal Disease.

Alternatively, you may be eligible for Medicare if you are eligible to receive Social Security or Railroad Benefits, or if you are currently receiving them. You may also be eligible if you or your spouse had Medicare-covered government employment.

The downside is that these conditions only cover you for Medicare Part A. Patients who want to benefit from Medicare Part B have to need to pay for it. This is a monthly premium which will be deducted from your Social Security, Railroad Retirement benefit or Civil Service Retirement Check. If you don’t receive these benefits, Medicare will send you a bill for your Part B coverage. If you want to check your eligibility, Medicare have a handy eligibility tool so that you can check if you can get coverage.

What Can Medicare Offer Me in Terms of a Wheelchair?

Medicare Part B covers both power-operated wheelchairs, known as scooters, and manual wheelchairs under their durable medical equipment coverage. To gain this coverage, your doctor must prescribe durable medical equipment to you and state that you require it for your condition. Medicare will only cover a wheelchair that’s only used outside of the home, it must be dual purpose for both inside and outside the home.

Generally, you will pay around 20% of the Medicare approved amount once you have paid your deductible for the year.  Through Medicare, the agreed amount will be lower than the actual charge for the item, so it is always better value.  Medicare offer two options to obtain your wheelchair, buying and renting.

Buying the Wheelchair

If your supplier is approved by Medicare, they may allow you to buy the item. In most cases, the item is rented on a monthly basis, but it is possible that Medicare will assist you to buy inexpensive medical items. Luckily, this includes wheelchairs. If you do decide to buy your wheelchair, you will pay only 20% of the cost and your cover will also insure you for repairs and replacement parts. If the wheelchair is lost, stolen, or damaged, it may be replaced under the same cost conditions.

Rending the Options

For those who are rending your wheelchair, Medicare will pay monthly for the item. Similarly, Medicare will pay for 80% of the cost once your annual deductible is paid, so you only have to pay a small amount. This is a more inexpensive option and can be better for medical items which need to be frequently serviced, as is the case with electric wheelchairs, or for temporary users of the equipment. The supplier will then pick up the equipment when you no longer need it. Under this scheme, any repairs or replacement parts are the responsibility of the supplier, so you won’t incur any extra cost for those as you would if you were to buy the equipment.

How Do I Get a Wheelchair Through Medicare?

The process of getting a wheelchair on Medicare can be a little complex, so we’ll break it down for you into easy steps.

  1. First, make sure you are covered by Medicare Part B.
  2. Schedule a doctor’s appointment and explain why you need a wheelchair. Highlight specific issues you are having or tasks you can no longer perform because of your condition and why you think a wheelchair is best suited to aid you, rather than a cane or a walker.
  3. Discuss with your doctor whether a manual or electric wheelchair would be better suited for you. Powered wheelchairs will need you to demonstrate that you have the capacity to control it safely. Manual wheelchairs will require the strength to propel yourself, or the aid of a helper.
  4. At this point, if your doctor agrees a wheelchair is what you need, they will sign a Certificate of Necessity. Once you have this, make sure you are aware that you will have 45 days to purchase a wheelchair.
  5. Next, you need to pay your yearly Medicare Part B deductible. This is an out of pocket expense which will open up the use of Medicare Part B to you.
  6. Decide whether you will buy or rent your wheelchair and understand the costs involved with both of these options.
  7. Find a Medicare-approved supplier and get in contact to organize delivery and payment. 

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