Does Insurance Cover Wheelchairs?

Wheelchairs are a vital mobility aid for individuals with limited mobility, whether due to aging, injury, or disability. 

However, the cost of these devices can be prohibitive for many people, raising important questions about coverage options. 

Does insurance cover wheelchairs? 

This is the key question we’ll explore in this in-depth guide, where we will delve into the policies of private insurance providers, Medicare, and the potential out-of-pocket costs that may come with obtaining a wheelchair.

We will also examine the types of wheelchairs covered by insurance, and whether electric wheelchairs receive similar coverage. 

Our aim is to equip you with essential knowledge and strategies for obtaining a free or discounted wheelchair if necessary.

Key Takeaways

• Private Insurance Coverage: Most private insurance companies do cover wheelchairs under their durable medical equipment (DME) coverage. However, the coverage extent and prerequisites may differ between insurance providers.
• Medicare Coverage: Medicare Part B generally provides coverage for wheelchairs classified as DME, given certain conditions are met, including a doctor’s prescription and purchasing from a Medicare-approved supplier.
• Out-of-Pocket Costs: Even with insurance coverage, there are often out-of-pocket costs associated with acquiring a wheelchair. These may include deductibles, copayments, and coinsurance. The specifics depend on the terms of your insurance policy.
• Coverage for Electric Wheelchairs: Many insurance providers, including Medicare, can cover motorized or electric wheelchairs. However, additional conditions typically need to be met compared to manual wheelchairs, such as a greater demonstrated need.
• Types of Wheelchairs Covered: Insurance coverage can extend to various types of wheelchairs, from basic manual models to complex electric ones. The type of wheelchair approved for coverage often depends on the individual’s specific mobility needs as assessed by a healthcare provider.

Do Insurance Providers Usually Cover Wheelchairs?

Most private health insurance providers classify wheelchairs as DME, and thus, they usually provide coverage for them. However, the extent of coverage and the requirements may vary greatly between different providers. The coverage is often subject to your policy’s deductible and coinsurance rules, which means that you may still have to bear a portion of the cost.

In many cases, insurance providers require a prescription from a doctor or physical therapist stating that the wheelchair is medically necessary. They may also require documentation outlining why less expensive mobility aids, such as canes or walkers, will not sufficiently meet your needs.

You can find more about this topic by reading our detailed guide on mobility aid insurance.

Qualifying for Wheelchair Insurance Coverage

To qualify for wheelchair insurance coverage, there are typically several requirements you must meet. Firstly, a doctor or other licensed healthcare provider must certify that the wheelchair is medically necessary. This certification should clearly state that the wheelchair is needed for daily living activities and that other less expensive mobility aids will not suffice.

Furthermore, your insurance provider may only cover your wheelchair if it is purchased or rented from a supplier within their network. Therefore, it’s critical to check whether your preferred supplier is covered by your insurance.

Keep in mind that these are general guidelines, and the exact requirements can vary depending on your insurance provider and policy. Always check with your insurance company for their specific conditions.

For more on this topic, read our article on wheelchair buying guide.

Does Medicare Cover Wheelchairs?

Medicare, a federal health insurance program primarily for individuals aged 65 or older, offers coverage for wheelchairs under certain conditions. According to the Medicare rules, durable medical equipment (DME), such as wheelchairs, can be covered if they are deemed medically necessary by a doctor and prescribed for use in the patient’s home.

For Medicare Part B to cover a wheelchair, your doctor must first document in your medical record that the wheelchair is needed and prescribe it for you. The wheelchair must then be purchased or rented from a supplier that is enrolled in the Medicare program, a topic covered in this article about Medicare-approved mobility scooters.

Keep in mind that Medicare Advantage Plans (Part C) also cover wheelchairs, but the exact coverage and out-of-pocket costs will depend on the specific plan. It’s crucial to check with your plan provider to understand your coverage better.

Out-of-Pocket Cost of Getting an Insurance-Covered Wheelchair

Even if your insurance, including Medicare, covers wheelchairs, you may still be responsible for certain out-of-pocket costs. These can include deductibles, copayments, and coinsurance, which vary depending on the specifics of your insurance plan.

For example, under Medicare Part B, once you’ve met your yearly deductible, you typically pay 20% of the Medicare-approved amount for the wheelchair. This percentage is known as coinsurance. The Medicare-approved amount is the limit that Medicare sets for what doctors, hospitals, and other healthcare providers can charge for covered services.

It’s important to check with your insurance provider or Medicare to get an accurate understanding of your potential out-of-pocket costs. If cost is a significant concern, consider exploring options for a free wheelchair.

Does Insurance Cover Electric Wheelchairs?

Most insurance companies, including Medicare, do provide coverage for electric wheelchairs if they are deemed medically necessary by a physician. However, the criteria for qualifying can be stricter compared to manual wheelchairs.

This is largely due to the higher cost associated with electric wheelchairs, and the fact that they are often viewed as a luxury item rather than a medical necessity. For instance, you might need to demonstrate that your mobility impairment is severe enough that a manual wheelchair would not suffice for you to perform daily living activities. More details on this can be found in our comparison between mobility scooters and electric wheelchairs.

What Kinds of Wheelchairs Does Insurance Cover?

The types of wheelchairs that insurance covers vary depending on the insurer, the specific policy, and the patient’s medical condition. Most insurance policies will cover basic manual or power wheelchairs. However, coverage for specialized or customized wheelchairs, such as bariatric wheelchairs or beach wheelchairs, might be more limited or require additional justification.

It’s also important to note that insurance companies often require a “Certificate of Medical Necessity” from your healthcare provider to confirm that the wheelchair is essential for your daily life.

How Much Does a Wheelchair Cost?

The cost of a wheelchair can vary greatly depending on the type, brand, and features. On average, a basic manual wheelchair can range from $100 to $500, while a more advanced or specialized model can cost several thousand dollars. Meanwhile, electric wheelchairs typically start at around $1,000 and can go up to over $15,000 for high-end models. This wheelchair cost guide provides a comprehensive breakdown.

Remember, these costs can often be significantly offset by insurance coverage, but it’s still important to understand the potential expense upfront.

Ways of Getting a Free or Discounted Wheelchair

If insurance coverage is not an option, or out-of-pocket costs are still too high, there are several alternative ways to obtain a wheelchair for free or at a discounted rate:

1. Non-Profit Organizations: Some non-profit organizations offer free or low-cost wheelchairs to those in need. Examples include the Wheelchair Foundation or Free Wheelchair Mission.
2. Government Programs: In addition to Medicare, state Medicaid programs or the Department of Veterans Affairs (VA) might offer assistance for those who qualify.
3. Equipment Loan Programs: Some organizations lend out medical equipment, including wheelchairs, for short-term use.
4. Used Wheelchairs: Buying a used wheelchair can be a cost-effective option. You can find helpful tips in this used wheelchair buying guide.
5. Community Fundraising: Websites like GoFundMe allow individuals to raise funds for personal needs, including wheelchairs.

These resources could potentially provide you with a free or discounted wheelchair, helping to improve your mobility and quality of life without the hefty price tag.

All the claims made in this article are only for informational purposes, based on the writer’s experience and not clinical advice. You should always consult your physician or physical therapist if you have any doubts about how this applies to your specific case.