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You may have discovered that getting the wheelchair you need is a lot more complicated than you initially thought. You want to be able to roll around and enjoy your life. For many, Medicare coverage for a wheelchair is the best way to get one at a reasonable price without breaking the bank.
But it’s not as easy as you think, and there are several steps you need to take to make sure you get approved for Medicaid coverage for wheelchairs in your state. In this article, we’ll walk you through all the steps you need to take to get a wheelchair on Medicare.
How To Get A Wheelchair With The Medicare Part B Benefit
Getting a wheelchair on Medicare is pretty simple. To get a wheelchair with the Medicare Part B benefit, you have to complete three simple steps:
First, you must have a doctor’s prescription for the chair. Your doctor will issue a Medical Certificate of Necessity [Medicare will request a signed Certificate of Necessity from a doctor] that says that you need a wheelchair to be mobile and independent.
Second, you will need to contact your local social security office and ask them for an application for Medicare Part B benefits. You can find out more about this process by contacting your local social security office or visiting their website.
Third, your chair is covered under these benefits once you have been approved for Medicare Part B benefits. Medicare will cover 80% of the cost of the wheelchair, while the recipient generally pays 20% of the Medicare-Approved cost.
Medicare will not pay for the wheelchair until you have met your deductible. At the moment [Febuary 2024], you have to pay $233 for your Part B deductible. This means you pay at least $233 of out-of-pocket medical expenses before the Medicare Part B benefits are applied to your wheelchair cost.
One recommended way to secure a wheelchair from Medicare is by purchasing one at a Medicare-approved medical supply store that sells Durable Medical Equipment (DME). You can find a Medicare-approved medical supply store near you using this store directory or via the Medicare helpline, 1-800-MEDICARE (1-800-633-4227).
The supplier will send a representative to your home for a home evaluation to ensure the product [wheelchair or scooter] purchased is best suited for home use. With that said, you should check out our guide on the best wheelchair-accessible house plans.
In the United States, we have a system in place called Medicare. This program helps cover medical issues faced by citizens over a certain age. If you are disabled by a severe illness or accident, Medicare can help cover your health expenses and equipment, including a wheelchair, if you meet certain conditions.
What Kind Of Wheelchair Will Medicare Cover?
The type of DME Medicare will cover depends on your condition and your doctor’s recommendations. Generally, Medicare will cover the cost for a manual wheelchair, power or electric wheelchair, and mobility scooter.
Medicare will replace any durable medical equipment that you rent or own at any time if it is lost, stolen, or damaged beyond repair in an accident or a natural disaster, so long as you have proof of the damage. Medicare will also cover the repair cost for worn DME if the equipment has not reached the end of its lifetime (Minimum of Three Years).
This can save many people from having to pay for new equipment if they cannot afford it.
Will Medicare Pay For A Wheelchair Rental?
If your wheelchair is a rental, Medicare will cover the costs for up to 13 months. After 13 months, the equipment will be yours, and you’ll have to cover another tremendous cost.
Conditions To Recieve A Wheelchair From Medicare
If you meet any of these conditions, then you’ve met the criteria to receive a wheelchair from Medicare:
You must have Medicare Part B coverage.
You must have a health condition that limits you and cannot do daily chores or activities like bathing, dressing or using the restroom with the use of a cane, crutch, or walker.
You must be able to operate the equipment or have someone assist you in using the device safely.
Am I Eligible For A Wheelchair From Medicare?
You are not eligible to receive the assistance or durable medical equipment from Medicare if:
Your condition allows you to use a cane, crutch, or walker.
You want to use the equipment outside your home.
You want to use the equipment for leisure or recreational activities.
How To Appeal A Declined Wheelchair Request From Medicare
You can file an appeal if you disagree with Medicare’s coverage or payment decision. If Medicare declines your wheelchair request, pays less than 80% payment, or what you believe is your fair share, filing an appeal is the best course of action.
To file an appeal, you have to review the Medicare Summary Notice and follow the instructions written behind the document. If you have
After you file an appeal, the original decision will be reviewed and revisited. If your appeal doesn’t decide in your favor, it can be reviewed by an independent organization.
You must know that your appeal must be filed within 120 days of receiving the MSN.
What Type Of Medical Equipment Will Medicare Cover?
Medicare coverage varies from state to state. In some states, Medicare will cover a specific type of medical equipment, while in other states, it won’t.
Medicare usually covers Durable medical equipment (DME) helps you complete your daily activities such as walkers, wheelchairs, mobility scooters, hospital beds, portable oxygen equipment, prosthetics, and orthotics.
Will Medicare Pay For A Lift?
A lift chair is a chair that can be raised off the ground to be used by someone in a wheelchair. Lift chairs are usually prescribed to assist patients with severe arthritis, muscular dystrophy, or other neuromuscular diseases. This makes it durable medicare equipment.
If a doctor recommends a chair lift and fills out a certificate of medical necessity for you, Medicare will cover 80% of the cost of a chair lift.
Will Medicare Pay For A Wheelchair Van?
Medicare will not pay for a wheelchair van.
The following are the reasons that Medicare will not pay for a wheelchair van:
Medicare will not pay for any vehicle used primarily to transport people with disabilities, including vans.
A wheelchair van is usually designed to accommodate wheelchairs or scooters; it doesn’t count as a home of DME for home.
A wheelchair-accessible van will not improve your ability to function in your daily activities even if you cannot use public transportation.
Will Medicare Pay For A Wheelchair Ramp?
Although wheelchair ramps are necessary for wheelchair users, it doesn’t count as durable medical equipment. With that said, Medicare Part B will not cover the cost of a wheelchair ramp.
Will Medicare Pay For A Wheelchair Cushion?
Medicare will pay for a general use seat cushion and a wheelchair seat cushion for individuals with a manual or power wheelchair that meets Medicare coverage criteria [sling, solid, or back seat]. Medicare will pay for a new cushion every three years.
Medicare Part B will pay for a wheelchair or accessories if you need them due to a medical condition. This includes people with MS and other diseases or injuries that cause permanent disability, such as the body’s loss of use of arms, legs, and torso. The catch is Medicare only covers 80% of the bill, which means the beneficiary is responsible for paying the remaining 20%.
Hopefully, this has given you some good insight into getting a chair with Medicare. If there is anything, you’d like to add, please feel free in the comments!
Wheelchaired is a proud member of the United Spinal Association and a disability blog dedicated to sharing guides and advice on issues concerning disability, mobility, accessible travel, and personal development.
