How Much Does Medicare Pay for a Wheelchair?

Medicare pays for a wheelchair only if certain criteria were met prior to the rental or purchase of one. If payment is approved, Medicare will cover 80 percent of the approved amount after you have met your deductible. You are responsible for the remaining 20 percent of the balance.

• Don't get stuck with the bill for your wheelchair.

Wheelchair Coverage Precautions

• In order for Medicare to cover 80% of the approved amount you must make sure that you have established the following:

  Medicare Part B
  You must have Medicare Part B Coverage. Medicare Part B covers outpatient (outside of the hospital) health expenses like doctors' visits, supplies and equipment. Part A covers inpatient hospital expenses. If you do not have Medicare Part B your wheelchair purchase or rental will not be covered.

  Medical Necessity
  Your doctor will deem a wheelchair medically necessary if it allows you to live more independently, helping you to do daily activities such as: bathing, going to the bathroom, getting out of bed, dressing or moving about the house.

  Prescription
  You must have a written prescription for the wheelchair from your doctor before you purchase or rent a wheelchair. Without one your wheelchair purchase or rental will not be covered by Medicare.

  Equipment Provider
  Your medical supplier must accept assignment from Medicare. This means that it contracts with Medicare and agrees not to charge more than the predetermined Medicare amount. Every supply or piece of equipment has a preapproved amount or price. This price is the amount on which Medicare bases its 80 percent coverage. Prices vary by category and state. If the equipment supplier is not contracted with Medicare you are entirely responsible for the cost of the wheelchair.

What Constitutes Medical Necessity?

• A doctor will assess your medical need for a wheelchair by using the following criteria:

  You are unable to walk even with help from other walking aids such as a cane or walker.
  You would be bed-ridden or confined to a chair if you did not have a wheelchair.
  You are able to function the wheelchair properly and able to transfer in and out of the chair safely.
  The chair will help you become more independent inside the home.

Who Can I Rent or Purchase a Wheelchair From?

• You must make sure you purchase or rent your chair from a contracted Medicare supplier. Medicare suppliers have a Medicare Supplier number. Each supplier must meet strict criteria in order to qualify, ensuring that supplies and equipment meet government quality standards. Before you get any information or arrange for any rental or purchase make sure to ask if the company is an approved Medicare supplier.

Purchasing a Wheelchair

• Medicare pays 80 percent of the rental fees for the first 13 months of rental. You are responsible for the remaining 20 percent. After 10 months, should you decide to purchase the chair Medicare, will send you a form to complete and will then pay 80 percent of the rental fee for the final three months. After that, you will own the chair and will be responsible for all maintenance charges on the chair.

Renting a Wheelchair

• Should you decide to rent a wheelchair, Medicare will cover 80 percent of the rental fees for 15 months; the remaining 20 percent is your responsibility. After that time you will have use of the chair for as long as you need it but you will not own the chair. The supplier will maintain ownership of the chair and will charge you a maintenance and service fee every 6 months. This charge is your responsibility and is not covered by Medicare.