Insurance Coverage of Wheelchairs, Power Wheelchairs and Scooters
Does Medicare cover the cost of wheelchairs? This is one of the most common questions we receive and the short answer is Yes. However, a better question would be, will Medicare cover the cost of a wheelchair for me? The answer to this is somewhat more complicated and it depends on the type of wheelchair, as well as your specific needs.
For Medicare to pay for a manual wheelchair, a senior must have a condition that prevents them from moving around in their home and completing their activities of daily living. Their disability cannot be resolved through the use of a cane or walker and the wheelchair cannot be necessary only for use outside the home.
For Medicare to pay for a powered or electric wheelchair (sometimes called a scooter), the individual must have the same needs as for a manual wheelchair. But they cannot have the physical strength to operate it. As well, they must show they have the ability to control the powered device without hurting themselves or those around them.
In either case, getting Medicare to pay is not an easy task. A written order from a doctor is necessary, and must state the medical reason for the need and the type of wheelchair that is required. When Medicare does pay, typically they will cover 80% of the approved cost. Often if an individual has Medicare Supplemental Insurance, they will pay the remaining 20%.
Did You Know?
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Medicare Supplemental Plans
Supplemental insurance plans do not offer coverage for additional products or procedures that are not covered by Medicare. These insurance programs instead help to pay for copayments and Medicare’s deductibles. So if approved by Medicare for an electric wheelchair, a Medicare supplemental insurance plan would likely pay for the 20% of the cost which Medicare does not.
Contrary to common belief, Medicaid is not a single program. Rather, there are different Medicaid programs for different groups of individuals. As examples, there is Medicaid for pregnant women, developmentally disabled children, low-income families, and the elderly. Each program has different eligibility requirements and different benefits. Furthermore, every state has its own version of these programs. In discussing Medicaid’s wheelchair and scooter benefits, we focus only on programs relevant to the elderly. What follows is written in general terms. Some states’ Medicaid rules may fall outside these norms.
Medicaid does pay for both wheelchairs and power wheelchairs or scooters. But how it does is largely dependent on where the individual who requires the wheelchair lives: in a nursing home, in assisted living or at home. For persons who live in Medicaid funded nursing homes, usually the wheelchair or powered wheelchair is provided to them when the nursing home staff recognizes the need.
Persons who receive Medicaid coverage while living at home or in assisted living are typically on Medicaid Waiver programs. Each Waiver program has different policies with regards to durable medical equipment. But generally speaking, the policy mirrors that of Medicare. If the individual cannot perform their activities of daily living within their home without a wheelchair, then Medicaid will cover the cost. If they cannot physically manage a manual wheelchair, then Medicaid will cover the cost of a power wheelchair. It is worth noting that the inability to manage their activities of daily living is something that must be determined by a physician. A friend or family member cannot simply make that determination and expect Medicaid to pay for the wheelchair.
Financial Assistance Programs for Wheelchairs and Scooters
Unfortunately, it is nearly impossible to provide a definitive answer to the question of whether the VA will pay for a power wheelchair or a manual one for any one specific person. Certainly both scooters and arm-powered chairs are covered benefits for some veterans. But there are many factors that determine what type of wheelchair and how much of the cost is covered. These factors include, but are not limited to, the type of disability, whether one’s disability is related to one’s military service, and one’s personal financial resources.
It is best to contact the VA directly to determine if a wheelchair, powered or otherwise, is a covered benefit for the veteran who requires assistance.
In related assistance, the VA offers several grants that are designed to help veterans make home modifications to make their homes wheelchair accessible (or to account for other disabilities). These are the Specially Adapted Housing (SAH) Grant, the Special Home Adaptation (SHA) Grant and the Home Improvements and Structural Alterations (HISA) Grant.
State Based, Non-Medicaid Programs
Many states have non-Medicaid based financial assistance programs for the elderly and disabled. While most of these programs are intended to provide services to help individuals remain living outside of nursing homes, some of them also provide assistance for durable medical equipment, such as wheelchairs, scooters, lifts, and ramps to make a home wheelchair accessible. Unfortunately, due to recent economic cutbacks, the list of state programs that do offer assistance is growing shorter, not longer.
Non-Profit Organizations and Foundations
Assistance is available from local non-profits or the local chapters of national foundations. However, oftentimes the available assistance comes not in the form of financial help for wheelchairs, but rather as long-term loans of the equipment or through the sale of heavily discounted, refurbished, power wheelchairs and ramps. A short list of non-profit organizations that provide help with wheelchairs can be found here.
Paying Out of Pocket
For the individual who cannot receive assistance from Medicare or any other source and must pay out-of-pocket for a power or manual wheelchair or electric scooter, there are a number of considerations of which they should be aware.
Any money spent out-of-pocket is tax deductible. If the individual is filing their own taxes, they can receive a tax deduction under Medical and Dental Expenses. If the individual is being claimed as a dependent on someone else’s tax return, they have the option of using that same deduction or using the Dependent Care Tax Credit, whichever is more advantageous to the tax filer’s situation.
Average Wheelchair Costs
Mobility scooter prices usually begin around $600 and go to $2,000. Pricing variables include maximum weight capacity, whether they have 3 or 4 wheels and travel distance without a battery recharge. Users of this website can receive 25% off purchases.
Power wheelchairs are slightly more expensive, as they range from $1,000 – $3,500. Pricing variables include the steering mechanism, their speed, travel distance and turning radius.
Manual wheelchairs are less costly. A basic model is around $100 and the higher end models can cost as much as $750. The primary pricing variable is the weight of the chair. Other factors include the ability to tilt and fold the chair.