Does Medicare pay for wheelchairs and scooters?

Whether or not Medicare pays for the price of a mobility machine like a guide wheelchair, energy wheelchair or electrical scooter is determined by whether or not you meet all its necessities.

“It’s not the easiest thing in the world,” says Diane Omdahl, creator of Medicare for You and cofounder of the Medicare advisory agency, 65 Incorporated.

Guide wheelchairs, energy wheelchairs and scooters

To clear up any confusion about terminology: a guide wheelchair is one you propel or your caregiver does; an influence wheelchair (additionally known as an electrical wheelchair or energy chair) is for folks missing the motor operate or cardiovascular energy to function a guide wheelchair and an electrical or energy scooter helps customers who can’t function a guide wheelchair and may’t use canes or walkers.

Even when you qualify for Medicare reimbursement for a mobility machine, you’ll be on the hook for 20% of the permitted quantity — your coinsurance — after paying your Half B deductible, which is $240 in 2024.

Guidelines for Medicare reimbursement

The primary rule for Medicare protection of a wheelchair or scooters is that you should have a medical want for one in your house.  

“That doesn’t mean you have to use it exclusively in your home, but that you need it in your home,” says Casey Schwarz, senior counsel for schooling and federal coverage on the Medicare Rights Center.

Medicare received’t cowl the wheelchair or scooter when you solely need the machine for comfort or when touring. Conventional Medicare additionally received’t pay for a house wheelchair ramp.

The second rule for reimbursement is what Medicare calls “limited mobility.”

Meaning having all of those:

• A  well being situation inflicting vital problem transferring round at house
• An lack of ability to do each day residing actions like bathing, dressing or utilizing the toilet with assist from a cane, crutch or walker
• The flexibility to securely function a wheelchair or scooter or somebody all the time obtainable that will help you do it

Cross these checks and also you’ll want a face-to-face examination from a physician (who should take part in Medicare). The doctor will then undergo Medicare a Certificates of Necessity saying you have got the medical want and that they’re treating you for the situation.

It’s possible you’ll want prior authorization from Medicare to get reimbursement for an influence wheelchair, That’s true whether or not you’re in conventional Medicare or a well being insurer’s Medicare Benefit plan. Medicare’s web site has a list of greater than 40 energy wheelchairs requiring prior authorization.

“The supplier and your health provider will submit the prior authorization,” says Schwarz. “If it’s denied or that you must present extra info, you may submit a brand new request.

Purchase vs. lease

You possibly can both purchase or lease wheelchairs and scooters. Guide wheelchairs are likely to value between $1,000 and $2,000; energy wheelchairs can run nicely over $10,000. Electrical scooters go for about $600 to $4,000. Leases are sometimes $100 to $400 a month.

Usually, when you lease a mobility machine, possession will switch to you after 13 months.

Medicare received’t change a wheelchair or scooter you lately purchased or started renting since you’re not pleased with it.

“If you have a chair that doesn’t fit you well and you’re not comfortable in it but Medicare already paid for it, they’re not going to give you another one for five years,” says Paul Lane, the accessibility specialist and tech entry lead for United Spinal Affiliation’s Tech Entry Initiative.

Medicare’s expanded wheelchair profit

Final yr, Medicare expanded its protection of energy wheelchairs to incorporate energy seat elevation. That characteristic helps customers attain counter tops and cupboards extra simply.

“This landmark Medicare decision to cover seat elevation is a major milestone that will improve the quality of life for so many who rely on this technology,” says Chiquita Brooks-LaSure, the Facilities for Medicare and Medicaid Companies (CMS) Administrator in a press release.

You’ll want an analysis from a skilled medical skilled to qualify for the seat-lift profit.

The Independence By way of Enhancement of Medicare and Medicaid (ITEM) Coalition of teams such because the Medicare Rights Middle and the United Spinal Affiliation desires Medicare to additionally cowl power-standing options for wheelchairs.

“Standing wheelchairs can cut down on pressure sores and increase bowel and bladder function,” says Lane.

CMS has stated it plans to contemplate masking them sooner or later.

The place to get wheelchairs and scooters

To purchase or lease a wheelchair or scooter and get reimbursed by Medicare, that you must go to a sturdy medical gear provider that takes Medicare task. You will discover ones close to you on the Medicare.gov site.

Don’t buy a wheelchair at a drugstore or division retailer simply because it’s handy and also you assume the shop has Medicare certification. “If you go to a corner pharmacy in a remote area, I doubt they’re certified,” says Omdahl.

Watch out with nomenclature: A provider that’s Medicare-approved however doesn’t take task would possibly cost you extra for a wheelchair or scooter than Medicare’s permitted quantity.

Medicare Benefit guidelines

Medicare Benefit plans from non-public well being insurers (the choice to conventional Medicare) have their very own networks of wheelchair and scooter suppliers in addition to their very own mobility-device protection guidelines.

“I found one Medicare Advantage insurer that will transfer ownership of a wheelchair to the user after 13 months, a second that will transfer certain items and one that never transfers no matter how many co-payments you make,” says Omdahl.

Getting an evaluation first

Before you purchase or lease a wheelchair or scooter, your physician or the gear provider should go to your property to confirm you could really use it there.

The sturdy medical gear provider could ship an authorized Assisted Expertise Skilled (ATP) to make the evaluation and to find out the chair or scooter options you want and that Medicare will approve.

“They’re pretty well versed. They’ll say, ‘Medicare won’t pay for that. Medicare won’t pay for this.’ They guide you along the way,” says Lane.

Slim doorway issues

A house evaluation is critically necessary earlier than getting a wheelchair since some fashions are too large to suit by means of doorways.

“I had a chair five or six years ago and it was just huge and hard for me to get into different doorways in my home,” says Lane. “I would scrape up a lot of walls.”

Omdahl remembers when she was a house care nurse serving to a girl with a damaged hip who acquired a wheelchair that didn’t match by means of her bed room door. “I moved the bed into the doorway and taught the woman how to stand up and hop on her bed,” Omdahl says.

The United Spinal Affiliation web site has user reviews of hundreds of wheelchairs. You possibly can search by mannequin, producer or sort.