Medicare is a federally funded program, designed to provide health insurance to people age 65 and over and certain people with disabilities, who are blind, totally and permanently disabled and have been receiving Social Security disability payments for 24 months, or who have end-stage renal disease. The Centers for Medicare & Medicaid Services (CMS) runs the Medicare program, and the Social Security Administration helps by enrolling qualified participants into the program. Medicare has several parts. Part B is the medical insurance part of Medicare that pays for Durable Medical Equipment (DME), such as an electric wheelchair or mobility scooter. For Part B carriers to reimburse for DME, such as a power mobility device, certain conditions must be met. The DME must be necessary and reasonable either in the treatment of an injury or illness, or in improving the function of an impaired body part. The DME must also be for use primarily in the individual’s home. The Medicare beneficiary must have a face-to-face mobility-focused examination and a written prescription from a doctor or other treating practitioner, and the equipment must be medically necessary based on Medicare’s coverage guidelines.
Will Medicare Pay for an Electric Wheelchair?
Medicare may pay for an electric wheelchair if you qualify. Medicare may cover the cost of a power mobility device for use in your home. Motorized wheelchairs are covered only when they are deemed medically necessary. To qualify, there are several steps that need to be completed.
- Schedule a face-to-face examination with your doctor or other treating provider to discuss your limited mobility. Your doctor must first consider the use of a cane, walker, manual wheelchair and scooter before considering an electric wheelchair. You must have a face-to-face exam and a special prescription from your doctor before Medicare helps pay for a power wheelchair.
- Have your physician send the prescription and your medical records to your authorized Pride provider. The provider must receive all paperwork within 45 days from the date of your face-to-face examination with your doctor. Once your provider receives the prescription and your medical records, they will work with you and your doctor to determine the best electric wheelchair that meets your needs.
- Your provider will assess your home to ensure you have enough space to drive and maneuver an electric wheelchair. If you have Traditional Medicare, the primary reason for DME is to enhance mobility within the home. A provider will consider your ability to perform activities of daily living, such as eating, grooming, bathing and toileting with the help of a power wheelchair. The home assessment is vital to ensure your living environment can support the use of an electric wheelchair.
- Following a successful home assessment, your provider will order a power wheelchair as prescribed by your doctor. The provider will deliver it to your home and instruct you how to use it.
To begin the process of obtaining a power wheelchair or mobility scooter through Medicare, you need to find a local DME supplier in your area. Click here to find a Pride provider. The Official U.S. Government Site for MedicareMedicare Coverage of Manual Wheelchairs and Power Mobility Devices