If you are approaching Medicare eligibility and have mobility problems, coverage for a wheelchair may be very important to you. Fortunately, Medicare has great benefits for durable medical equipment (DME), including canes, walkers, and wheelchairs.
Medicare is made up of two parts: hospital benefits and outpatient benefits. Part A covers inpatient hospital stays and Part B pays for your outpatient medical needs. DME falls under Part B.
Let’s look at Medicare’s rules for obtaining a wheelchair and how Part B pays for that equipment.
Qualifying for a Wheelchair under Medicare Guidelines
In order for Medicare Part B to cover your wheelchair, your Medicare doctor must write a prescription. The prescription needs to document that you have a true medical need for a wheelchair that you can use to move around your home. The wheelchair cannot be just for outside activities. There must be a need for it in your home.
The doctor must also declare that you have a health condition that causes limited mobility or inability to walk around your home. This health condition must be one that makes it difficult for you to complete ordinary activities of living such as bathing or dressing.
You must also be able to demonstrate that you can safely operate a wheelchair. If you cannot operate it, there must be someone else that you live with you can help you operate in a safe manner.
Obtaining a Wheelchair from a Medicare Supplier
Medicare has a competitive bidding program which helps keep costs down for both Medicare and for you. In certain areas of the country, you must purchase your wheelchair from one of these Medicare-approved suppliers.
You can find DME providers by visiting Medicare’s website and using their Find a Supplier tool. Once you find a supplier, you present the prescription from your Medicare doctor. You must order the wheelchair within 6 months of your face-to-face visit with your doctor.
Your Costs Under Part B for a Wheelchair
Medicare Part B pays for 80% of the cost of your Part B services an equipment after you first pay the annual deductible, In 2018, that deductible is $183.
You are responsible for the other 20% coinsurance. If you have a Medicare supplement policy, it will pay some or all of your 20% share depending on which Medicare supplement plan you enrolled in.
Medicare supplements are standardized by the federal government so that you can easily compare benefits between policies. Plan F and Plan G are the most comprehensive plans. Both will pay your 20% share. These two plans also pay any excess charges that you may incur if your doctor does not accept Medicare’s assigned rates.
Some people choose to enroll in a Medicare Advantage plan instead of a Medicare supplement. These plans are private Medicare insurance plans that have their own rules and cost-sharing. If you are enrolled in one, consult your Summary of Benefits for information about your cost-sharing responsibility.
Written by Danielle Roberts
Danielle Roberts is a senior executive at Boomer Benefits where she and her team help people navigate their entry into Medicare.