Electric Wheelchairs and Medicare: What is Covered?

If you’re having mobility problems you might qualify for an electric wheelchair under Medicare coverage. An electric wheelchair solution can greatly improve the quality of life for mobility impaired patients and is well worth considering as an available option.  The new Electric wheelchair provisions from May 2005, allow for partial or complete coverage of an electric wheelchair, based on the need of the patients.

Patients requesting an electric wheelchair must show that their mobility impairments are interfering with their ability to take care of themselves within the home. Medicare will want to know if your mobility problems interferes with essential daily activities such as, toileting, feeding, dressing, grooming and bathing in the usual locations in the home.

 

Medicare will also want proof that an electric wheelchair is the best solution, and will want documentation on, why a cane or walker won’t solve the mobility issues? Why a conventional manual wheel chair cannot be used? Why an electric scooter cannot be used? Whether the patient has the mental and physical faculties to operate an electric wheel chair; and whether the patient has demonstrated a desire for, and a willingness to learn how to use, the electric wheelchair?

Medicare will also want to see that the patient can safely transfer in and out of the electric wheelchair, and that the person has the necessary core trunk strength and stability to safely operate an electric wheelchair. Medicare will also insist that the patient not have successfully filed a claim for reimbursement for the purchase of an electric wheelchair in the previous five years.

 

These questions will need to be answered by your physician, so you will need to get a face to face mobility evaluation from a registered physician before proceeding with your application for an electric wheelchair.  Normally, Medicare insists that the consulting physician be a licensed neurologist, orthopedic surgeon, rheumatologist, or rehabilitation medicine specialist. Medicare will cover up to 80% of the total cost of the wheelchair, and additional insurance coverages often pay for the balance of the cost.

Claims issued to Medicare for an electric wheel chair will be settled within 30 days of receipt of the claim. Medicare clients are advised to apply for pre approval prior to purchasing the electric wheel chair, to ensure that payment is made.

Although the number of claims approved by Medicare has went up substantially in the last ten years, studies have shown that these approvals have actually resulted in a net savings for Medicare. Patients who receive adequate mobility assistance devices are far less likely to suffer a broken hip or other related ailment.

3 Responses to Electric Wheelchairs and Medicare: What is Covered?

  • valerie brown says:

    I HAVE A QUESTION WHEN A PAITENT JUST HAVE MEDICAID INSURANCE HOW LONG DOES THIS PROCESS FOR THEM TO GET A MOTORIZED WHEEL CHAIR IS IT MORE THAN 3 MONTHS ?

  • Angela Williams says:

    Hello, I am the rehab director and physical therapist at a SNF in tallahassee. I have a resident who is really young but at the same time her moblity is signifantly decreased secondary to moribid obesity, poor balance, and decreased respiratory capacity. she only has medicaid. so my question is, will medicaid cover for he to get a power chair without medicare?

  • Richard Howard says:

    A friend of mine had just been provided a new electric chair paid for by medicaid or medicare. The chair cost $4600.00 and he never used the chair before he died unexpectedly. Can my friend sell the chair or will medicare want it back?

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