Medicare and Electric Wheelchairs

Medicare is a federally funded insurance program available to most Americans over the age of sixty-five. It is designed to provide affordable health care and covers the cost of doctors visits and prescriptions. In addition to providing coverage similar to that of private insurance, Medicare also covers the cost of Durable Medical Equipment, which is a broad category consisting of many types of home medical equipment.

Wheelchairs, both manual and electric, fall into the category of Durable Medical Equipment and are typically covered by Medicare.

While electric wheelchairs are covered by Medicare, the insured must meet several requirements in order for the device to be covered. One of the main requirements is that the individual is unable to use a manual wheelchair. They must also be able to transfer into and out of the wheelchair and able to operate the electric wheelchair in a safe manner.

In addition to the above physical requirements, the electric wheelchair must also be prescribed by a doctor as part of a treatment plan. In most cases, Medicare will only cover one electric wheelchair every five years, so if they have previously provided reimbursement for a wheelchair, it might not be available.

With a doctors prescription and assuming the insured meets the other physical requirements, Medicare will typically provide reimbursement for up to 80% of the cost of an electric wheelchair. Some companies will directly bill Medicare, although it is usually also possible to buy the electric wheelchair first and apply for reimbursement later. However, if you go this route ensure that you meet Medicare’s requirements first and will be eligible to receive reimbursement.

For those who use a Medicare Advantage Plan (MMA) the rules for reimbursement may vary, so it will be necessary to check with the company that runs this plan. A Medicare Advantage Plan is available to those eligible for Medicare and covers the same things as traditional Medicare, but is run by a private insurance company. As a result, the way some things are covered and reimbursement received can be a little bit different, but Medicare Advantage Plans are required to cover the same things as traditional Medicare.