Manual Wheelchairs

Will Medicare Cover Manual Wheelchairs?

Yes, Medicare will cover manual wheelchairs. However, you must be able to show you have an honest medical need for a manual wheelchair and the primary use must be for moving around your home. In other words, it just can't be something that would be nice to have or primarily for use outside the home. However, you must follow the steps below to ensure that Medicare pays for the equipment:

Only your doctor can prescribe the equipment for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you.
The doctor must document the need in your medical records and give you a signed and dated order (prescription) for the equipment.

How Do I Qualify For a Wheelchair?

You must have Medicare Part B coverage and you must have been assessed by your doctor. The doctor must have documented your need in your medical record, and wrote you an order (prescription) for the equipment. The supplier must have the order on file before billing for the chair. In addition, the need for the wheelchair must meet the following criteria:

You cannot walk, even with the support of other mobility equipment (canes, walkers, etc.)
You would spend most of your time in bed or in a chair without the use of a wheelchair
You can transfer safely in and out of the wheelchair
You are able to sit and ride safely in the wheelchair and can operate the controls
The primary reason for needing the item is to help you move about independently, not to prevent an injury from occurring where no injury or illness exists (even through it will help prevent injury, as well).
The primary use will be inside the home. Although you can also use the wheelchair while outside the home, it may not be for use only when outside the home setting.

Wheelchairs require a Certificate of Medical Necessity. Your doctor and Medicare supplier will know when that documentation is required.

How much does it cost for Manual Wheelchairs?

After you have paid your annual deductible, you will pay 20 percent of Medicare-approved amounts for the wheelchair purchase or rental and maintenance. Those costs may be higher if the supplier doesn't accept the assignment. Wheelchairs are in the "Capped Rental" category which means you may choose to rent or purchase a wheelchair. Once Medicare has made 10 monthly rental payments you will be given an opportunity to purchase the wheelchair. The supplier will send you a 'Purchase Option' letter in the ninth month of the rental. You will have 30 days to reply.

If you reply and want to buy the wheelchair:

Medicare will make three more payments and the chairs is yours
You will be responsible for maintenance (Medicare will cover 80 percent of the total maintenance cost). It is the patient's responsibility to find a Medicare approved supplier for the maintenance.

If you do not answer or choose to continue renting:

Medicare will make a total of 15 rental payments and the wheelchair is yours to use as long as you need it.
The supplier keeps ownership of the chair and is responsible for maintaining it
You will be charged a maintenance and service fee every six months. Medicare will pay 80 percent of the maintenance and service fee.

Where Do I Purchase Wheelchairs?

You will save money if you order your items from a Medicare approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your wheelchair from any store that sells them. However, if the supplier from which you order your chair is not enrolled in Medicare, Medicare will not pay for the equipment.

Things you should think about before you choose a supplier:

There are two types of Medicare suppliers, participating suppliers and those who are enrolled, but have chosen not to participate.
Participating suppliers must accept assignment, which means they agree not to charge more than the Medicare allowed amount.
A Medicare approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the chair. In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple months to receive payment.
If you receive your Medicare coverage through a Medicare Advantage Plan (HMO or PPO), it is likely that the plan will have its own steps for the purchase. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers -- they cannot supply less. Depending on your plan you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan's customer service and ask about your coverage before you order your chair.

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