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).
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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.
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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:
- Manual wheelchairs
- Power-operated vehicles/scooters (including folding mobility scooters covered by Medicare)
- 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.
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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.
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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.
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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.
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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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Hi medicarefaq.com webmaster, Great job!
I have back issues an cannot walk very long outside of my home to do grocery shopping or just an outing .I am in pain management now having injections. Would I be eligible for a scooter through Medicare? If so how would I go about getting one? Thank you for any help.
Hi Carolyne – we would recommend talking to your doctor. If they can certify that your condition qualifies you for a scooter, Medicare will likely cover due to medical necessity.
Where can you go to see what each of the power wheelchairs looks like and the dimensions. I have an old home and I need one that is no more than 23″ wide.
I guess I’m a little confused. You stated if it was medically necessary but also in other comments that it would have to be needed inside the home. Some people like me can manage inside the house but need a chair for outdoor use. Will Medicare help under those circumstances?
Hi Phil! Yes, the wheelchair must be medically necessary and used inside the home. If the equipment is only needed outside the home, you may still be able to get it covered by Medicare. Your doctor would be best to ask.
Hello,, I have group insurance through my spouse as primary. I have numerous problems my primary one pays have of s powerchair will Medicare pay secondary for my my power chair difference 2400.00 ?
Hi Denise! Did you enroll in Part B or delay enrolling since you had creditable coverage through your spouses’ employer?
No, I just enrolled to not be late. Medicare B has paid 2ndary. Just not sure why Hover round power chairs . priority health sends claims to Medicare after they process. Will Medicare pay secondary
Yes, as long as the supplier is approved by Medicare, Part B will pay secondary.
G. Anton:
My sister is confined to a bed (due to inability to use her legs) in a CT nursing home and she is covered by both Medicare & Medicaid (Max allowable assets $1,600). They do have manual wheelchairs available: however, due to poor arm strength, she must wait for assistance to get her out of bed using a sling and someone has to push her around.
Any idea if she would be she would be covered by either/both Medicare and/or Medicaid for a motorized chair/scooter in a nursing home? Of course she now has the Stimulus money to also help pay any additional costs. Thank you
Hello! As long as your sisters’ doctor says a motorized wheelchair is Medically necessary, Medicare will cover it. I’m not sure about Medicaid, you would need to contact your local SHIP department to find out if Medicaid will also cover it. Medicaid has different rules per state.
My brother has a powerchair supplied by medicare .Unfortunately the supplier fitted him for one that is too large to get through most of the doors in his home.We have tried to make it work for over a year but it is doing damage to the chair and to the doors in his home.My question is: can we sale this one so we can afford to buy another that is more suited to him?We realize that medicare will only replace chairs every 5 years.(he is a large man so I quess they thought he needed a large chair) Thank you for taking my question
Hi Debra. In this scenario, I would call Medicare directly and explain the issue to see if they can help in any way. They may work with the supplier to get your brother a chair that is fitted better for his home. Make sure to have pictures of his chair including damage to the house, as well as any documentation on hand when you call them.
Hi, I have Medicare and Medicaid. Will they both cover the cost of a scooter?
Hello! If you meet the requirements in the article that Medicare says you must meet to qualify for a scooter, Medicare will help cover the costs. Regarding Medicaid, this depends on many other factors, including the state you live in. You would want to call Medicaid to see what your state rules are to verify if they will help cover the costs.
I have COPD with complications from multiple lung cancer radiation treatments to both lungs. I’m currently on oxygen 24/7. My walking problems have to do with breathing. I currently live in an independent living section of a senior community. I can move around my studio apartment okay and do daily things there, but when it comes to walking to the dining room or to the grocery store on premises or to the pharmacy or any of the other facilities they have here for the seniors, I’m unable to make that trip without becoming breathless. Does this sound like a reason a motorized wheelchair would be covered? I have Medicare Plan A and B and I also have Medicare Supplemental Coverage Plan F.
Hi Nancy, thank you for your question! A great rule of thumb to go by regarding this is the term “medically necessary.” As long as your doctor finds a motorized wheelchair medically-necessary, then Medicare will pay for it. The great news is, you have the most comprehensive coverage you can get. Your Plan F will cover all the cost-sharing left over after Medicare pays their portion of the costs. I would start by reaching out to your doctor. They will be able to start the process. I hope this helps!
I have COPD. Do I qualify for a mobility scooter under Medicare?
Hi Patricia! The rule of thumb is as long as your doctor finds it medically necessary, Medicare will help pay for it. In order to qualify, your ability to walk must be seriously compromised. You would need to have a face to face appointment when your physician and get a written prescription. I hope this helps!
i need a wheelchair or scooter so i can go out and not worry about falling i asked my doctor about and he puts me off but my arthritis doctor says i need one
I need a scooter to be able to go out of the house. I cannot walk without severe pain in my legs and feet due to a back injury. I also have neuropathy, fibromyalgia, arthritis and broken down feet. I cannot move well in a wheel chair and with support I can walk around the inside of my house. My house is not wheelchair accessible. Would I be eligible for a scooter under these circumstances with help from my doctor?
Hello! If you’re unable to do normal day to day activities inside your home, then your doctor should be able to provide you a prescription for your scooter.