Does Medicare Cover Wheelchairs?

According to Medicare.gov, Medicare Part B (Medical Insurance) will cover power-operated vehicles, such as scooters and manual wheelchairs, when prescribed by a doctor for at-home use. Prior to Medicare paying for the power wheelchair, though, you must meet face-to-face with a doctor or other treating provider and receive a prescription.

Original Medicare Costs

If your supplier chooses to accept the assignment, you will then be responsible for paying 20% of the Medicare-Approved Amount. The Part B deductible does happen to apply here. Medicare will pay for different kinds of durable medical equipment (DME) in a few different ways.

DME factors that could ultimately affect Medicare coverage include the following:

• Renting the equipment.
• Buying the equipment.

Medicare will only cover the medical equipment if your doctor and medical supplier are enrolled currently in Medicare. In order to stay enrolled in Medicare, suppliers and doctors must meet strict set standards. Medicare will not cover either if they are not enrolled.

Make sure to know ahead of time if both your doctor and supplier are enrolled before moving forward with the process. Participating suppliers need to meet assignment, which means they can only charge you for coinsurance and the Part B deductible for the amount that has been approved by Medicare. Essentially, there is no limit on what suppliers can charge a patient when they are not participating in Medicare.

Medicare Approvals And Denials

In September 2018, it was ruled that individuals must get “prior authorization” for different kinds of power wheelchairs. There are currently 40 kinds of wheelchairs that require this prior approval. Prior authorization is needed before Medicare will approve covering the cost of said wheelchair.

DME suppliers will need the following to receive approval:

• Request prior authorization ahead of time.
• Submit the request and other required documentation to Medicare.

Typically, the patient does not have to do anything in this scenario. The supplier will be responsible for all the work, at this point. Your specific DME supplier needs to send the request for authorization and all documentation to Medicare on your behalf. Medicare will review the request and documentation to ensure you are eligible for the coverage.

Authorization could potentially be denied due to the following:

• Medicare finds that you do not medically need a power wheelchair.
• Medicare did not receive sufficient documentation for the approval.

How Much Do Wheelchairs Cost On Average?

The three main types of wheelchairs are manual, transport, and electric. Costs can range all the way from $90-$9,000, depending on the type of chair needed. Prices will undoubtedly vary by model, with the transport version being the least expensive and electric being the most expensive, overall.

Let’s take a look at some average costs associated with these models.

• Average Transport Wheelchair Cost: $955.
• Average Manual Wheelchair Cost: $1,400.
• Average Electric Wheelchair Cost: $3,750.

*These are cost estimates according to Braunability. 

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Phone: (623) 975-0880