will medicare pay for electric wheelchair ?

If you or a loved one is considering purchasing an electric wheelchair, you may be wondering if Medicare will help cover the cost. Medicare is a federal health insurance program that provides coverage for a variety of medical needs, including durable medical equipment (DME) like electric wheelchairs. Understanding how Medicare coverage works for electric wheelchairs can help you make an informed decision and alleviate some of the financial burden associated with these devices.

What is Medicare?

Medicare is a federally funded program primarily designed for people aged 65 and older, but it also covers certain younger individuals with disabilities or specific medical conditions. Medicare has different parts that cover different types of services, such as:

Part A (Hospital Insurance): Covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care.
Part B (Medical Insurance): Covers outpatient care, preventive services, ambulance services, and durable medical equipment (DME), including electric wheelchairs.
Part C (Medicare Advantage): A private insurance plan that includes both Part A and Part B benefits, and sometimes additional benefits.
Part D (Prescription Drug Coverage): Covers prescription medications.

Does Medicare Cover Electric Wheelchairs?

Yes, Medicare may cover the cost of an electric wheelchair, but there are specific conditions that must be met in order for coverage to apply. Electric wheelchairs are considered durable medical equipment (DME), which is generally covered under Medicare Part B. However, to qualify for coverage, the following criteria must be met:

Medically Necessary: Medicare only covers electric wheelchairs if they are deemed medically necessary. This means that your doctor must determine that you have a medical condition that severely limits your ability to walk and that an electric wheelchair is the most appropriate option to help with mobility.
A Doctor’s Prescription: You need a prescription from your doctor to obtain an electric wheelchair under Medicare. The prescription must specify that the wheelchair is medically necessary and outline your specific mobility needs. The doctor must also provide a written statement that outlines your limitations, such as being unable to walk a certain distance or stand for long periods.
Coverage for Specific Conditions: Electric wheelchairs are typically covered if you have a qualifying condition that impacts your mobility, such as severe arthritis, neurological conditions, or other disabilities. However, the coverage is contingent on your inability to walk or self-propel a manual wheelchair.
Certified Supplier: To be covered by Medicare, the wheelchair must be provided by a Medicare-approved supplier. It’s essential to ensure that the supplier meets Medicare’s requirements, which may include certification for providing specific types of medical equipment. The wheelchair must also meet certain specifications set by Medicare for durability and safety.

What Will Medicare Pay For?

Medicare will generally pay for the basic electric wheelchair (often called a power wheelchair), which is used for indoor or limited outdoor use. The amount that Medicare pays will vary depending on the type of wheelchair and whether or not you meet the necessary conditions for coverage.

Typically, Medicare Part B will cover 80% of the Medicare-approved amount for the wheelchair after you’ve met your deductible, and you will be responsible for the remaining 20%. If you have a Medicare Advantage plan (Part C), the coverage and cost may vary based on the specifics of the plan.

Coverage for Wheelchair Accessories

In some cases, Medicare may also cover certain accessories or additional features for your electric wheelchair if they are medically necessary. These might include:

Specialized seating systems
Elevating leg rests
Custom cushions or supports
Power tilt or recline functions

These accessories must be deemed essential for your medical condition and mobility needs.

Steps to Get Medicare Coverage for an Electric Wheelchair

Visit Your Doctor: Schedule an appointment with your primary care physician or a specialist to discuss your mobility needs. Your doctor will assess your condition and determine if an electric wheelchair is necessary.
Get a Prescription: If your doctor believes an electric wheelchair is medically necessary, they will provide a written prescription for the equipment.
Find a Medicare-Approved Supplier: You’ll need to purchase your wheelchair from a supplier who is approved by Medicare. Make sure to check that the supplier meets all the necessary requirements to avoid any delays in the approval process.
Submit Documentation: The supplier will need to submit the necessary documentation to Medicare, including your prescription, medical records, and any other required paperwork. Medicare will then review the information to determine if you qualify for coverage.
Cost and Payment: Once approved, Medicare will pay 80% of the cost of the electric wheelchair, and you will be responsible for the remaining 20%, which may be covered by supplemental insurance, Medicaid, or out-of-pocket if necessary.