If you’re planning to request a wheelchair through Medicare, it’s important to understand what’s required, the process to have your request approved, and how much you can expect to pay.
Does Medicare Pay for Wheelchairs?
Medicare Part B (medical insurance) covers durable medical equipment, which includes wheelchairs. Generally speaking, Medicare will cover your wheelchair if your doctor submits a written order stating that you need one and that you have limited mobility with all of the following conditions:
A health condition that makes it difficult to move around your homeAn inability to do activities of daily livingAn ability to safely operate a wheelchair, including getting on and off (or you have someone who can help you do so)A doctor and wheelchair supplier who both accept MedicareA doctor or supplier who has visited your home to verify you can use a wheelchair there
Power vs. Manual Wheelchairs
Medicare Part B covers both power and manual wheelchairs. However, not everyone will be eligible for both. To qualify for either a power or manual wheelchair, you’ll need a written statement from your doctor stating that you need one. You’ll only qualify to have your power wheelchair covered if it’s deemed to be medically necessary.
Buying vs. Renting
Depending on your situation, you may be able to either rent or buy medical equipment. In some cases, Medicare will decide which is most appropriate for your situation. In other cases, you may be able to decide whether to buy or rent. Generally speaking, Medicare only buys inexpensive equipment such as canes and walkers. For other equipment, it defaults to renting. However, after 13 consecutive months of renting, it will switch from a rental to a purchase. Another situation where Medicare might buy your equipment is if you already own a covered device. In that case, Medicare may pay to repair your device or replace individual parts. Medicare may also replace your equipment if it’s lost, stolen, or damaged beyond repair.
How To Get Medicare To Pay for Your Wheelchair
If you’re trying to qualify for a wheelchair through your Medicare coverage, it’s important that you follow the appropriate steps.
How To Appeal a Denial of Coverage
Even with a written order from your doctor and prior authorization from your supplier, Medicare could still deny your request. This is likely to happen if Medicare either finds you don’t medically require a wheelchair or didn’t receive enough information to make a decision. If Medicare denies your request and you disagree with the decision, you still have some options. First, resubmit your prior authorization. If that doesn’t work, follow the Original Medicare appeals process. Here’s how to file your appeal:
What Costs You Need To Cover
If Medicare approves your request for a wheelchair, you’ll still be on the hook for some costs. First, you’ll have to meet your deductible for the year. For 2022, the Medicare Part B deductible is $233. Once you’ve met your Medicare Part B deductible, you’ll pay a 20% coinsurance for durable medical equipment, including wheelchairs. Medicare will pay for the other 80%.
Fill out the “Redetermination Request Form” and send it to the company that handles your Medicare claims.Send a written request to the company that handles your Medicare claims.
Your name, address, and Medicare numberThe decision you’re appealingWhy you’re appealing the decisionThe name of your appointed representative, if you have oneAny other information that may help your case
The Bottom Line
Wheelchairs are covered under Medicare Part B as a part of the coverage for durable medical equipment. You’ll qualify if you have a health condition that requires a wheelchair and your doctor provides a written order for one. The requirements may be slightly different depending on whether you’re requesting a manual or power wheelchair. As a result, it’s important to research the process ahead of time to improve your chances of having your request approved the first time.
