Mobility is crucial for the elderly and disabled community. For many, an electric wheelchair can significantly enhance quality of life. However, the cost of these essential aids can be prohibitive.

It's important to find suppliers who accept Medicare to ensure coverage for electric wheelchairs.

Understanding whether Medicare covers electric wheelchairs and the steps to obtain one can make a world of difference for those in need.

In this guide, we’ll explore everything you need to know about Medicare coverage for electric wheelchairs, helping you make informed decisions for yourself or your loved ones.

Understanding Medicare Coverage

Medicare is a federal health insurance program primarily for people aged 65 and older, but it also covers certain younger individuals with disabilities. Original Medicare refers to the traditional Medicare program consisting of Parts A and B. Knowing what each part of Medicare covers is essential to navigating its benefits.

Medicare Part A and Part B

Medicare Part A covers hospital inpatient care, skilled nursing facility care, hospice, and some home health care. It is not designed to cover durable medical equipment (DME) like electric wheelchairs.

Medicare Part B, however, covers outpatient care, preventive services, and DME. If you’re considering an electric wheelchair, Medicare Part B is the part that may offer Medicare cover.

Medicare Part C (Medicare Advantage) and Part D

Medicare Part C, also known as Medicare Advantage, includes all benefits and services covered under Part A and Part B, often including additional benefits like vision, hearing, and dental.

Coverage for electric wheelchairs under Medicare Advantage plans can vary, so it’s crucial to check plan specifics. Beneficiaries should also check if their plan participates in Medicare's Competitive Bidding Program when looking for suppliers.

Medicare Part D covers prescription drugs and does not pertain to electric wheelchair coverage.

Key Takeaways

Understanding the distinctions between Medicare parts can clarify which services and equipment are covered. 

For electric wheelchairs, focus on Medicare Part B and review any additional benefits from a Medicare Advantage plan.

Eligibility for Electric Wheelchairs and Durable Medical Equipment Under Medicare

Not everyone qualifies for an electric wheelchair under Medicare. Specific criteria must be met to ensure coverage. Individuals with limited mobility or a qualifying disability may be eligible for Medicare coverage for electric wheelchairs.

Medical Necessity

First and foremost, Medicare requires that the need for an electric wheelchair be medically necessary. This means that a physician must determine that a wheelchair is required for daily living activities within the home and that you cannot perform these activities with a manual wheelchair, walker, or cane. A power wheelchair may be considered medically necessary if the individual cannot use a manual wheelchair due to their condition.

Physician's Order

A written order from a Medicare-enrolled physician is essential. The order should specify the patient’s mobility limitations and how these limitations affect daily activities. The physician's order should also include details necessary for getting the wheelchair approved by Medicare.

Additionally, the physician must document that the patient can safely operate the electric wheelchair.

Home Assessment

Medicare also requires an assessment of the patient's home to ensure it can accommodate the electric wheelchair. This includes checking door widths, maneuvering space, and flooring conditions. 

The home must be accessible enough to use the wheelchair effectively.

The Process of Obtaining an Electric Wheelchair Through Medicare

Once you determine eligibility, understanding the process of obtaining an electric wheelchair through Medicare is crucial. Medicare will pay for a portion of the cost of the electric wheelchair if all requirements are met. Here’s a step-by-step guide to help you through the application and approval process.

Step 1: Initial Consultation

Start with a visit to your primary care physician. Discuss your mobility challenges and express your interest in an electric wheelchair. 

Your physician will evaluate whether an electric wheelchair is medically necessary and provide a written order if approved.

Step 2: Obtain Written Order

After receiving the written order from your doctor, take it to a Medicare-enrolled supplier of durable medical equipment. 

The supplier will use this documentation to initiate the approval process.

Step 3: Home Assessment

The supplier will conduct a home assessment to ensure your living space is suitable for an electric wheelchair. They will check for obstacles that might prevent safe and effective use of the wheelchair.

Step 4: Submit Documentation

The supplier will submit all necessary documentation, including the physician's order and home assessment results, to Medicare for approval. 

This documentation must clearly demonstrate the medical necessity of the electric wheelchair.

Step 5: Await Approval

Medicare will review the submitted documentation. If approved, Medicare will cover 80% of the cost, leaving the patient responsible for the remaining 20%. Medicare covers different types of power wheelchairs, and the approval process may vary based on the type.

If denied, you can appeal the decision with additional supporting information.

Alternatives and Additional Assistance

Not everyone will qualify for an electric wheelchair through Medicare. Fortunately, there are other options and resources available to help you obtain the mobility aids you need. The Centers for Medicare & Medicaid Services (CMS) may offer additional programs to help cover the cost of electric wheelchairs.

Medicaid and State Programs

If you do not qualify for Medicare, Medicaid may be an option. Medicaid coverage varies by state, so it's essential to check specific state programs and requirements. 

Some states offer additional assistance programs for the elderly and disabled that can help cover the cost of an electric wheelchair.

Veterans Affairs (VA)

If you’re a veteran, you may qualify for a mobility scooter through the Department of Veterans Affairs (VA). The VA offers a range of benefits for veterans, and mobility aids are often included. 

Contact your local VA office for more information on eligibility and the application process.

Non-Profit Organizations

Several non-profit organizations offer grants and assistance for mobility aids. Organizations like the Muscular Dystrophy Association (MDA) and the ALS Association provide resources and financial aid for those in need of electric wheelchairs.

Financing Options

For those who do not qualify for any assistance programs, financing options can help. Many durable medical equipment suppliers offer payment plans and financing options to make electric wheelchairs more affordable.

Here at Electric Wheelchairs USA, we’ve partnered with three financial institutions to provide you with the best financing options available. Make sure to read our financing section below!

Conclusion

Navigating Medicare coverage for electric wheelchairs can be complex, but it’s essential for improving the quality of life for the elderly and disabled. 

Understanding the different parts of Medicare, eligibility criteria, and the application process can help you or your loved ones obtain the necessary mobility aids. 

If you find yourself ineligible, exploring alternative options and additional assistance can still provide a pathway to independence and improved mobility.

For personalized guidance and support, consider reaching out to a Medicare consultant or a local healthcare advocate. 

They can offer tailored advice and help you through the process, ensuring you get the mobility aid you need.

And if you are planning on buying a new mobility scooter or electric wheelchair, but you’re not sure which option is best for you?

Then give us a call!

Our friendly Mobility Experts are ready to answer any questions you have.

Just give us a ring at 800-682-9444 or shoot us an email at info@electricwheelchairsusa.com. 

We love making this easier for you!

You might also love our articles “How Motorized Chairs For Seniors Help You Stay Active and Independent” and “Electric Wheelchair Versus Mobility Scooter: Which Is The Right Choice For You?”.

Need Financial Help?

Are you or a loved one in need of a reliable wheelchair? 

Our mobility experts are here to help! Give us a call at 800-682-9444 for personalized assistance.

Flexible Financing Options Tailored for Seniors:

• Klarna Financing: Spread the cost with easy installment plans through our trusted European banking partner.

• Shop Pay: Manage your payments effortlessly with clear, simple scheduling, thanks to our collaboration with Affirm.

• PayTomorrow: Enjoy a hassle-free application process, transparent pricing, and convenient auto-pay features—all designed to protect your credit score.

Don't wait… contact us today at 800-682-9444 and discover how you can get a new mobility scooter without straining your budget!

Feel free to reach out if you have any questions or need further assistance. 

We're here to support you every step of the way.