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Q: Will Medicare cover the cost of wheelchairs and walkers?
A: Yes. Medicare Part B covers a portion of the cost for medically-necessary wheelchairs, walkers and other in-home medical equipment. (Medicare will not cover power wheelchairs that are only needed for use outside the home.) Talk with your doctor about your needs. He or she can write a prescription that can be filled at a designated medical supply company.
As of September 2018, there are 33 types of power wheelchairs that require prior authorization. If your doctor prescribes one of these power wheelchairs and it’s medically necessary for use in your home, the durable medical equipment (DME) supplier will submit the prior authorization request and the necessary documentation to Medicare for review.
The Part B deductible will apply (if the enrollee has not already met the deductible earlier in the year; in 2020, the Part B deductible is $198), and in most cases, patients will also pay 20 percent of the cost after the deductible — or these costs can be covered by supplemental coverage, discussed below. In general, Medicare pays to rent the equipment on the patient’s behalf, rather than buy it. But there are some situations in which Medicare will purchase the equipment, so talk with your doctor and medical equipment supplier to be sure you understand how the coverage works.
Are there special requirements for my doctor to be able to order a wheelchair?
Both the doctor and the medical equipment supplier must be enrolled in Medicare in order for the claim to be covered, so double check before you purchase medical equipment. And you’ll want to understand the difference between providers that accept assignment with Medicare and those that don’t. A durable medical equipment supplier that’s enrolled in Medicare might not accept assignment, which means that the patient will end up paying more for the equipment. As long as the supplier is enrolled in Medicare and also accepts assignment, the patient will not have to pay more than the Part B deductible and 20 percent of the rest of the cost. (See page 12 of this booklet for more information on how this works).
How does competitive bidding affect Medicare's coverage for durable medical equipment?
You may live in an area that was using Medicare’s Competitive Bidding Program for durable medical equipment prior to 2019. Beneficiaries in those areas needed to make sure they were using a Medicare contract supplier, but because the Competitive Bidding Program resulted in lower costs on durable medical equipment, the portion that the patient paid was also lower. But for 2019 and 2020, there is a temporary gap in the Competitive Bidding Program for durable medical equipment. New contracts are expected to take effect as of January 2021.
What if I have coverage through Medigap or Medicare Advantage?
If a person has a Medigap (Medicare supplemental insurance) plan, it will likely pay all or a portion of the 20 percent coinsurance for durable medical equipment like wheelchairs.
Coverage of durable medical equipment will vary from plan to plan if the enrollee has Medicare Advantage coverage. These plans are required to cover the same things that Original Medicare covers, so they do provide benefits for durable medical equipment. But the specifics of the coverage will vary depending on the plan. In that case, the Medicare Advantage insurer will be able to explain the coverage details and what steps need to be taken (eg. a prescription from a doctor, prior authorization, etc.) in order to have coverage under the plan.
Used wheelchairs, walkers and basic medical supplies can also be found at even greater savings as church bazaars, estate sales, garage sales and online.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.