Does Medicare Cover Wheelchairs and Scooters?

If you’re a Medicare beneficiary with an injury or illness causing limited mobility, you may receive coverage for a manual Medicare wheelchair, Medicare-approved scooters, or power-operated device. Original Medicare (Medicare Part A and Part B) benefits cover these devices, specifically Part B, as they are considered durable medical equipment (DME).

But to receive coverage, you’ll need to understand the stipulations by which beneficiaries qualify for these benefits. Depending on the type of DME you require, your Medicare wheelchair coverage may require prior authorization to receive coverage. Additional considerations can come into play for beneficiaries with extra benefits such as coverage from a Medicare Supplement (Medigap) or Medicare Advantage plan. Furthermore, not all scooters are Medicare-approved mobility scooters.

Will Medicare pay for a wheelchair? Are Medicare-covered scooters available? Explore how you are covered, the regulations surrounding eligibility, how your coverage is affected by different Medicare benefits, and how you can help keep your costs as low as possible.

Does Medicare Pay for Wheelchairs?

Through Medicare Part B (Medical Insurance), you’re covered for wheelchairs when medically necessary. Medicare wheelchairs are covered as DME, but you’ll need to meet a variety of requirements in order to use your benefits.

Like all Medicare-approved benefit usage, you will need your doctor to determine that your wheelchair is medically necessary and must accept Medicare. In this instance, your wheelchair supplier must also accept Medicare. In addition to having limited mobility and the previously stated guidelines, you must meet all of the following requirements to receive wheelchairs covered by Medicare:

• Your health condition makes it notably challenging to move about your home.
• Completing normal activities of daily living, such as getting dressed or bathing, is not possible even when using a cane, crutch, or walker.
• Operating your wheelchair can be done safely, either independently or with the assistance of someone consistently available to you.
• You’ll need to have either your doctor or supplier visit your home to verify the use of the DME is reasonable for use within your home. For example, your doorways are wide enough to fit the equipment.

With Medicare wheelchair coverage, you pay 20% of the approved amount once your Part B deductible is paid for the year. Afterward, your Medicare benefits will pay the remaining 80%. For those with a Medicare Supplement plan, your benefits can help you cover the remaining out-of-pocket costs you may incur.

For beneficiaries with Medicare Advantage benefits, things may operate a bit differently. The cost of your wheelchair and the DME suppliers available to you can vary depending on your plan.

Unlike Original Medicare benefits, Medicare Advantage benefits come from private insurance carriers, and you’ll need to review your plan to better understand which costs are covered and the suppliers you are eligible to use.

A manual wheelchair is just a traditional wheelchair that you or someone else must push. This option requires you to maintain upper body strength to push yourself safely or to have someone available to help you safely get around the house in the wheelchair.

You’ll want to schedule an appointment with your primary care doctor or another doctor treating you. During this face-to-face appointment, you’ll want to discuss your mobility challenges and explain why you need a wheelchair or scooter.

Being unable to do regular, day-to-day activities inside your home, as listed above, are all acceptable reasons for requesting DME. You must communicate with your doctor about your limitations to ensure they prescribe you the correct type of device so that it can be deemed medically necessary for Medicare coverage.

Are Mobility Scooters Covered By Medicare?

Coverage for mobility scooters is available through Medicare, and in many ways, your benefits work the same way as they do for covering wheelchairs. However, to receive scooters covered by Medicare, you must show that you lack the upper body strength necessary to operate a manual wheelchair.

This designation must come from your primary care physician, who will certify your medical condition limiting your mobility. Your physician must state that you require a power scooter to get around inside your home and perform your daily activities.

Additionally, to receive coverage through Medicare, mobility scooters must be operated safely and accessible for the patient, either through independent means or through assistance from someone available to provide care.

What Scooters Does Medicare Cover?

Mobility scooters and covered by Medicare, and wheelchairs can come in many different forms. Your Medicare Part B benefits cover these pieces of equipment so long as you meet the necessary requirements and have your doctor write an order proving the medical need and the ability to operate such equipment safely. These include:

1. Manual wheelchairs
2. Power-operated vehicles/scooters (including folding mobility scooters covered by Medicare)
3. Motorized wheelchairs

Determining which specific wheelchairs and scooters are covered by Medicare can be tricky, as many different factors can go into which DME is available for your healthcare:

• You’ll need to meet requirements involving the feasibility of the equipment fitting and maneuvering within your home.
• The model you use will need to be safely operated as well as entered and exited by you alone or with help from a caregiver.
• Medicare Advantage plans may have specific models covered that may vary depending on your plan. In this instance, you’ll need to refer to your individual plan and carrier to understand which models are covered.

While not a comprehensive list, a core concern for beneficiaries with mobility issues remains determining which power wheelchairs require prior authorization. Thankfully, there is an extensive list of power wheelchairs covered by Medicare that require prior authorization available online.

Does Medicare Cover Electric Wheelchairs?

Electric wheelchairs on Medicare are available if you cannot operate a manual wheelchair, but you do not qualify for Medicare coverage for a power-operated scooter. But in order to receive Medicare-approved power wheelchairs, prior authorization will need to determine that they are necessary for your medical condition.

Your doctor will also need to conduct a face-to-face exam. During this exam, your healthcare provider will determine whether or not you can safely operate an electric wheelchair. After the review of your abilities to operate the DMR safely, if an electric wheelchair is deemed medically necessary and safe, your doctor then writes to Medicare explaining your need for the device and your ability to operate it safely.

Does Medicare Cover Knee Scooters?

Original Medicare and Medicare Supplement benefits do not cover knee scooters. Because they are not considered medically necessary DME, you’re going to have to pay out of your own pocket to cover these costs.

The possible exception would be for some Medicare Advantage beneficiaries. Because plans and their benefits vary from state to state and provider to provider, there are some instances in which knee scooters may be available at the discretion of your carrier.

Knee scooters are used by patients recovering from medical procedures, such as surgeries, suffering from long-term but non-permanent mobility issues. If you are going to require the use of a knee scooter and have a Medicare Advantage plan, it’s important to review your plan’s benefits beforehand to best understand how you are covered for this device.

Medicare Coverage for Power Wheelchairs and DME Prior Authorization

As mentioned above, you’ll need prior authorization for certain power wheelchairs before Medicare covers them. This means that before you can use at least 40 different kinds of power wheelchairs, you must receive this approval.

Medicare requires a prior authorization request from your power wheelchair supplier to determine if you’re medically eligible. If your doctor prescribes a power wheelchair, your DME supplier sends Medicare the documents for you. However, you can forward the request and documents to Medicare yourself.

Once Medicare reaches a decision, your power wheelchair supplier receives a letter outlining the determination. Remember, you can also contact your power wheelchair supplier and Medicare directly for the decision letter. Your request may be denied for the following reasons:

• Medicare determines you don’t medically need a power wheelchair.
• Medicare doesn’t get all the documents it needs to reach a decision.

If Medicare needs more information, your supplier will resubmit your authorization request. For power wheelchairs, Medicare will pay for their costs, but the process is necessary to help weed out potential fraud and preserve the benefit for those who are in need.

How Much Does a Scooter Cost When on Medicare?

If you qualify for a power scooter, you pay 20% of the allowable charges for your equipment plus any applicable deductible. On average, the price of a motor-powered scooter can range between $700-$2500+, so the total cost of your scooter may vary.

It’s also important to remember that depending on where you live, your equipment may be subject to Medicare’s competitive bidding program. If you live in an area where this applies, you must get your scooter from a vendor contracted with Medicare under the competitive bidding program, which helps lower the costs.

When picking scooters Medicare will pay for, make sure your supplier, as well as your doctor, are both currently participating in the Medicare program. Then, discuss your payment options and whether you should purchase or rent the wheelchair from the supplier.

The length of time that you’ll need the equipment will be a major factor in this decision. Because your Part B benefits only pay for a portion of the total cost, you’ll need to pay for the remaining 20% of the cost through other means. It’s important to understand how long you’ll need your wheelchair or scooter to determine which path is right for you.

While paying 20% of a $700, $1,000, or even $2,600 scooter or wheelchair is much better than paying for the entire thing, this is still a sizable amount of money to consider. Beneficiaries with Medicare Supplement plans can enjoy even fewer costs as their Medigap benefits cover these out-of-pocket expenses.

Handicap Scooters Covered by Medicare

Mobility scooters are Medicare-approved under the right conditions, and this benefit can be an important one for beneficiaries who are under the age of 65. While Medicare benefits become available to seniors who are 65 years of age and older with at least 40 work credits under their belt, disabled persons can also qualify for coverage.

If you receive Social Security Disability Insurance (SSDI) benefits, you can become eligible for Medicare benefits as well. But before qualifying, you’ll need to receive SSDI payments for 24 months, in addition to your 5-month waiting period before your benefits become available. Afterward, Medicare benefits are also available to qualifying beneficiaries not meeting the program’s age requirement.

However, this doesn’t change the process of Medicare coverage for scooters or wheelchairs. You’ll still need to go through the same steps and have a doctor determine that your device is medically necessary to obtain coverage, in addition to being capable of safely operating it.

Does Medicare Advantage Plan Help With the Cost of Wheelchair?

Medicare Advantage plans are required to offer you, at minimum, the same benefits Original Medicare does, except hospice care. This means that Medicare Advantage plans must provide you with the same 80% coverage on a wheelchair as traditional Medicare. However, they’re provided by private insurance companies, and the copayments and deductibles can vary.

In the event that your Advantage plan denies your request for a DME item or service, you believe you need, you can appeal the decision and receive an independent review. If you enroll in a new Medicare Advantage plan while receiving home care or prescribed medical equipment, contact your new primary care provider to ensure that you’re covered.

If your Medicare Advantage plan is discontinued while using medical equipment, contact your plan to learn how to get DME coverage through Original Medicare or another Advantage policy.

Additionally, wheelchairs that are Medicare-approved use can vary from plan to plan. If there is a particular model you are looking to use, you’ll need to be sure that your Medicare Advantage plan offers coverage for that specific model.

Furthermore, Medicare Advantage wheelchair ramp coverage may be available, but it is improbable. Although carriers can provide specific benefits that vary among plans, finding any form of health insurance covering the cost of ramps is unlikely.

How To Get a Wheelchair With Medicare Plus Supplement

Medicare Supplement plans provide beneficiaries additional coverage for any out-of-pocket costs associated with the price of Medicare-approved wheelchairs or scooters. This is because while a great benefit for covering healthcare costs, Medicare Part B alone can leave out-of-pocket costs behind.

There are 12 different lettered plans available for Medigap benefits, so how you are covered can vary. However, with supplemental coverage, you can still receive a Medicare wheelchair or scooter while covering the costs to obtain them.

The process is the same because rather than replacing your Part B benefits, your Medicare Supplement benefits will help cover you further for the same approved DME. Therefore, so long as you qualify for Medicare coverage for wheelchairs or scooters, you’ll be able to apply your benefits for your equipment.

How To Get Medicare Wheelchair Coverage and Medicare-Approved Scooters

Medicare-approved wheelchairs and scooters can help provide beneficiaries with viable solutions for improved mobility and quality of life. Depending on the type of benefits you’re enrolled in will affect how much your coverage will take care of the costs for you. At MedicareFAQ, we understand the challenges of finding and maintaining the right level of coverage.

Our licensed agents are here to help you cover Medicare-approved scooters, wheelchairs, and various healthcare needs. We identify your personal healthcare needs and then connect you with the best benefits for your unique needs, including Medigap or Medicare Advantage policies. To get help choosing the right benefits, call us today at the number listed above, or compare rates online by completing our rate form here.

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