If you or someone you know requires a power wheelchair, you may be wondering if Medicare will cover the cost.
The answer is Yes! Medicare Part B (Medical Insurance) covers power wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home. But, it is important to know certain eligibility requirements must be met in order to qualify.
How to Qualify for Medicare Coverage of a Power Wheelchair
The first requirement for Medicare coverage on a power wheelchair is that you must have a medical necessity. This means you have to speak to your doctor or primary care provider about your need for a power wheelchair. A face-to-face evaluation must be conducted to determine if a power wheelchair is medically necessary.
The next step after the medical necessity has been established is for you (or your representative) to provide evidence of your ability to operate and maintain the power wheelchair safely. This includes completing a skills demonstration in the presence of your doctor.
If all the above requirements are met, your PCP will then give a certificate, prescription, or a signed order for the power wheelchair.
It is important to note that you can only receive Medicare coverage for one piece of equipment at a time. If you have already received coverage for another piece of DME, you may not be eligible for Medicare to cover the cost of a power wheelchair.
How Often Will Medicare Pay for a Power Wheelchair?
The coverage of a power wheelchair is typically limited to once every 5 years. That means replacement can only be done once every five years. But, there are exceptions to this, so it is important to speak with your doctor or contact Medicare if you think you may qualify for a new power wheelchair sooner. Repairs are also covered by Medicare if the power wheelchair is still under warranty, so make sure to keep the warranty information handy.
How Long Does Medicare Take to Approve a Power Wheelchair?
After your provider or supplier sends the prior authorization request for a power wheelchair, Medicare will typically respond with an approval or denial within 10 days. In most cases, Medicare will approve the request and you can begin the process of ordering and receiving your power wheelchair.
Also, depending on your case or specific situation, it can be earlier if proven to be medically necessary and may cause harm without the equipment.
How Much Does a Power Wheelchair Cost?
There are many things that influence the cost of a power wheelchair. The type, manufacturer, and features all play an important role in figuring out the overall cost. Generally speaking, the power wheelchair can cost anywhere from $2,000 to $3,000. But we recommend speaking with your provider or supplier for the exact pricing of the power wheelchair you need.
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