How To Get a Portable Wheelchair From Medicare

Seniors who find themselves in need of a portable wheelchair for increased mobility may turn to Medicare for help with the cost. Unfortunately, Medicare does not always provide assistance with this expense, in addition to other medical and health care needs.

Medicare ensures medical insurance coverage for all seniors aged 65 and over, but it doesn't cover everything. Depending on the medical condition and the patient's Medicare plan, certain treatments and procedures may be covered, but there are often additional premium payments, co-payments, and deductibles for the patient to pay.

Medicare coverage is made up of four distinct parts: Part A (hospitalization insurance), Part B (out-patient expenses), Part C (Medicare Advantage) and Part D (expanded coverage for prescription drugs). For those over 65, Part A is an automatic enrollment with no premium to pay. Part C, Medicare Advantage, is an optional, expanded insurance offered by private companies for a nominal monthly fee. Part B provides coverage for various out-patient medical expenses, including wheelchairs. Part D is the additional coverage for prescription drugs.

Part B Medicare Insurance

Part B Medicare insurance can provide you with coverage for a variety of medical expenses, including doctor visits, x-rays, lab tests, some medicines, and items classified as durable medical equipment (DME). Unlike Part A, you must actively enroll for this coverage and pay a monthly premium. DME includes items you may need for your medical care, health, or safety while at home, such as a wheelchair. In certain cases, Part B may cover the cost of these items.

Wheelchair Coverage

Most of the time, Medicare will help you get the mobility support you need, especially when it comes to manual wheelchairs. Through Part B, Medicare can provide a wheelchair for mobility issues inside your home. Unfortunately, Medicare won't cover wheelchairs for outside use, unless specific rules and requirements are met.

The doctor treating your condition has submitted a written request to Medicare asserting that you require a wheelchair for your home, in order to manage your condition effectively.

Additionally, you have proven difficulty with mobility and meet all the criteria below.

You suffer from a health condition that significantly impairs your ability to move around in your home.

You may find yourself unable to complete even the most basic everyday tasks, such as getting in and out of bed, dressing, bathing, or using the restroom, even with the assistance of a cane, crutch, or walker.

You can confidently and securely maneuver in and out of your wheelchair, or enlist the help of a care provider who is always on hand to ensure safe use of the wheelchair.

The doctor treating you and the wheelchair vendor you've chosen are both enrolled with and officially approved by Medicare.

You can use the wheelchair safely and securely within the confines of your home – it's small enough to fit through doorways and won't be hindered by floor surfaces or objects in its way.

Types of Wheelchairs

Discover the two main types of wheelchairs available - manual and motorized. Many manual wheelchairs are designed to be easily transportable, with the ability to collapse or fold. Some motorized wheelchairs are also designed for portability. When it comes to covering the costs of a wheelchair, Medicare is much more generous when it comes to manual wheelchairs compared to motorized ones.

In order for Medicare to cover the cost of a motorized wheelchair, all the requirements must be fulfilled, plus:

Your doctor has determined that it is medically essential for you to utilize a motorized wheelchair, and has made the necessary documents and prescriptions.

The doctor has asserted that, for your safety, a motorized wheelchair is the only option, rather than a manual wheelchair.

The doctor personally examined you within 45 days of writing the prescription for your motorized wheelchair.

Getting your motorized wheelchair requires Medicare's approval first. This is called a "prior authorization" and can take up to 10 business days to receive. Make sure you get this approval before purchasing or renting the device.

Payments For a Wheelchair

Once you've made the necessary payments for your Part B premiums, you may have to meet a deductible before Medicare will contribute to your wheelchair costs. After that, Medicare usually pays 80% of the bill and you'll have to cover the remaining 20%. To make sure you're covered, it's important to use a medical equipment supplier that's enrolled and approved by Medicare. Depending on your situation, Medicare may cover the cost of renting or purchasing a wheelchair. Keep in mind, though, that they won't cover wheelchair ramps or any other related items, and you can only get one wheelchair covered at a time.