Does Medicare Cover Electric Wheelchairs?

If you or someone you are caring for has a problem with mobility and finds it difficult to use a manual wheelchair, an electric or power-driven wheelchair might be a better option to help you participate in normal activities more easily. Even though manual wheelchairs are lighter, less expensive, and easier to transport, power wheelchairs take less physical effort to run and have different seating options or greater comfort. 

You might need an electric wheelchair if you have had a spinal injury, or amputation, or have a debilitating condition like cerebral palsy, multiple sclerosis, or Alzheimer’s disease. If so, your Medicare benefits might cover a percentage of the cost to rent or purchase an electric wheelchair. 

Do Medicare Recipients Get Coverage for Electric Wheelchairs?

Original Medicare Part B (medical insurance) covers electric or power wheelchairs under the category of durable medical equipment (DME). Besides wheelchairs, this benefit also includes electric scooters and walkers.

You might qualify for an electric wheelchair if your healthcare provider, who accepts Medicare assignment, certifies that you can’t use a manual wheelchair or power-operated scooter after an in-person examination. If your healthcare provider feels that an electric wheelchair is your best option, he or she submits a written order to Medicare to prove that you have a medical need for one, that you can operate it, and it is for use at your home.

Medicare Wheelchair Eligibility Requirements

Medicare recipients must also meet the following conditions to be eligible for this benefit:

• Your mobility is limited because of a health condition.

• You can’t use a cane, crutches, or walker to do normal daily activities such as getting out of bed, going to the bathroom, bathing, or getting dressed.

• You can safely operate and get in and out of the wheelchair on your own, or you have assistance at all times.

• The health care provider who is treating you and the supplier of the equipment accept Medicare assignment. 

• You can use the electric wheelchair in your home without obstructions from doorways, floor surfaces, or other objects blocking your way.

Medicare Wheelchair Coverage

Original Medicare Part B pays for 80 percent of the Medicare-approved cost to rent or purchase your wheelchair and you pay the remaining 20 percent. You are also responsible for your Part B yearly deductible and your monthly premium. If you have a Medigap plan, you may have coverage for these costs depending on which plan you have.

If you have a Medicare Advantage (Part C) plan, your provider must cover the same benefits that Original Medicare Parts A and B cover. With a Medicare Advantage plan, you might have to rent or purchase your equipment from a supplier that is in the plan’s network. Make sure you check with your private insurance provider if you are sure about eligible suppliers and health care providers.

Another point to be aware of is that Medicare requires that you get prior authorization for some types of power wheelchairs before they approve your coverage. There are 33 types of wheelchairs on this list, so if your physician prescribes one, your Medicare-approved DME supplier must first request prior authorization and send the documents to Medicare for approval.

Your healthcare provider and supplier do the paperwork for you and you get the equipment unless Medicare doesn’t agree that the equipment is medically necessary or if they don’t get all the necessary information.

How Much Does it Cost to Buy or Rent an Electric Wheelchair?

There is a huge variety of electric and battery-powered wheelchairs available across the country today. Of course, the price you pay depends on the type you get, but the average cost of purchasing an electric wheelchair runs between $1,000.00 and $4,000.00. If you decide to rent one instead, prices are around $125.00 per week and $270.00 per month. With your Medicare benefits, you only have to pay a percentage of that cost.

Your healthcare provider can help you choose a wheelchair that fits your needs the best. Be sure to get detailed information about the available types of electric wheelchairs and the monthly rental charge before you make a commitment. You can find a qualified DME supplier in your area by calling your local Medicare office.