Does Medicare Cover Wheelchairs? Everything You Are Curious About!

Does Medicare Cover Wheelchairs? Everything You Are Curious About!

What is Medicare Wheelchair Coverage?

Knowing what Medicare coverage is involved when it comes to either purchasing or renting a wheelchair is very important. You want to ensure that you are prepared for any costs that may not be covered to ensure that you get the best device possible when it comes to your mobility and freedom. Medicare wheelchair coverage will cover the expenses involved in either renting or purchasing a wheelchair in certain cases. In order to be put forward for this kind of cover, a person will have to meet certain Medicare wheelchair requirements. These requirements are based on the extent of the need for a wheelchair device and are also dependent on where your mobility issues occur. Medicare Part B covers a person if they are having mobility issues within their own home but not if they are having mobility issues outside of the home. Understanding these different coverage points when looking at a wheelchair is vital, so be sure to enquire with your doctor about your condition and the best solution when it comes to wheelchair coverage. 

When Does Medicare Pay For an Electric Wheelchair or Wheelchair?

The following are the requirements you need to be approved for a standard or electric wheelchair covered by Medicare. 

  • You cannot take care of your own needs: If you are disabled and unable to take care of your daily needs within your home, you can be put forward to receive a Medicare wheelchair. Taking care of your daily needs refers to being able to move through your home and be able to do things like cook food and clean yourself. If you are unable to do these daily tasks safely, you may be eligible to receive a wheelchair from Medicare. It is important to note that a hospital or a nursing home will not qualify but any sort of long-term facility would. 
  • You are able to operate a wheelchair safely: A doctor will need to assess whether you are able to safely use a Medicare wheelchair device. This is to ensure not just the safety of the user, but also those around them. You may have to go through a short exam where reflexes are tested to ensure that you are capable of safely  maneuvering a wheelchair. 
  • You need a doctor's written authorization: In order to be approved to get a standard or electric Medicare wheelchair, you would need to get a written authorization from a doctor. A doctor will analyze your medical requirements and assess whether you require a wheelchair or not. When a doctor authorizes you for the wheelchair, you will then also need to be authorized by the supplier of the equipment. 
  • Your home needs to be wheelchair accessible: In order to be approved for a wheelchair supplied by Medicare, you need to prove that you will be able to use the Medicare wheelchair within your home. This will mean that you need to get in and out of the house (you may need a ramp if you have stairs) as well as have big enough doors for the wheelchair to get through. 

How To Get a Medicare Wheelchair?

When looking at how to get a wheelchair through Medicare, you will need to be assessed by a doctor who will determine what your needs are. If a doctor deems that it is necessary for you to have a wheelchair due to the disabilities you have, he will authorize you so that you can apply to a DME supplier. The DME supplier will submit a request to Medicare on your behalf, and if this comes back approved, you will be eligible to receive your wheelchair. To get approval from the right doctors and DME suppliers, be sure that the company and doctor are both approved by Medicare. 

Which Documents Are Required?

To get standard or  electric wheelchairs paid by Medicare, there are certain documents that will need to be submitted in order to get approval. The main documents that are needed are a doctor's certificate stating that you require a wheelchair and a request that will be submitted by a DME supplier. These two documents will go through and the request will either be accepted or you will be denied. If you are denied it may mean that you need more documentation to back up your request. 

Does Medicare Coverage Change If You Rent or Buy?

Medicare will either approve for you to rent or purchase a wheelchair, depending on the specific needs of the patient requesting the wheelchair. Medicare wheelchair coverage is all dependent on the needs of the patient and as some may require specific measurements or additions to ensure the chair is optimal for the unique individual, they may offer the funds for purchasing a wheelchair. In other situations, like those who require a wheelchair for a temporary time, Medicare wheelchairs will be provided through the rental of the device. 

Rent a Medicare Wheelchair

If a person is in temporary need of a wheelchair, Medicare may approve paying for a rental and not a purchase of a chair. Medicare will approve the rental according to the amount of time that it is deemed necessary by your doctor. A Medicare wheelchair may also be provided on a rental basis if the doctor estimates changes within the patient's condition that could lead to them requiring a new kind of chair. It is important to note that Medicare will usually only buy inexpensive medical equipment and the more expensive items, like wheelchairs, are often given out on a rental basis. So, how does Medicare cover wheelchair rental? Medicare will cover 80% of the costs involved in renting a Medicare wheelchair, either through a claim submitted by you or the provider of the device. 

Buying a Medicare Wheelchair

If it is estimated that you will need to use a wheelchair indefinitely or for an extended amount of time, you may be approved to buy a wheelchair with Medicare. This is also required when the doctor and supplier have requested that unique alterations may need to be made to standard devices. If your condition requires unique adjustments, Medicare will more than likely approve for you to buy a wheelchair rather than rent one. 

What Steps Should You Follow To Receive Payment From Medicare?

Most Medicare Part B claims are sent directly from the doctor or DME supplier to Medicare, making it easier for claims to be directed to the correct facility. If you have gone through a facility or doctor that is not part of Medicare, you have to pay for the products purchased directly and then send in a claim request. Claiming from Medicare involves submitting a request and proof of payment through the Medicare website. To lodge a claim you will have to fill out a form and provide any other supporting information that will prove that you have purchased a device due to the assessment done by a doctor. Once this claim has been lodged with Medicare, it will be reviewed and if accepted, the funds will be sent to you. This can often be a long process which is why it is important to consider going through doctors and DME suppliers who are connected to Medicare. 

How Often Will Medicare Pay For a Wheelchair?

More often than not, Medicare will only replace a wheelchair if there is an issue with it or it has broken. If you are hoping to know how often will Medicare pay for a wheelchair there is no exact timeline that will be set up to plan for a replacement, but you should definitely not expect one within five years of receiving a new one. Another important point to consider when it comes to the replacement of Medicare wheelchairs is that you will need to have owned the chair for its whole lifetime. 

What Are The Costs You Should Cover?

While Medicare does pay for a wheelchair that you will be able to use, unfortunately, Medicare coverage for wheelchairs will require you to pay a portion of the payment and meet certain requirements. The most important requirement is that you would need to have met your plan B deductible for that specific year. After this has been met, you will be required to pay 20% of the amount approved by Medicare as well as any extra costs that go above what you have been pre-approved for. If you would like Medicare to assess the amount that they have given, you will need to submit another application. 

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