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Electric Wheelchairs Covered by Medicare

Medicare Part B has a Durable Medical Equipment (DME) benefit that covers things like walkers, wheelchairs, CPAP machines, diabetic supplies, and more. However, Medicare has a specific process for determining coverage for each piece of durable medical equipment you need.

Generally, Medicare will cover the least expensive option that meets your medical needs. You will have to meet specific criteria for any upgraded versions of durable medical equipment.

Electric wheelchairs are an upgraded version of manual wheelchairs. While Medicare does cover electric/power wheelchairs, you have to clear a few hurdles before they pay.

How to Qualify For an Electric Wheelchair under Medicare

Medicare Part B only covers durable medical equipment that is prescribed by your doctor, so that’s the first requirement.
For Medicare to cover a manual wheelchair, you need to meet the following requirements:

  • You’ve been diagnosed with a medical condition that makes it difficult to move around your home.
  • You aren’t able to bathe, dress, use the bathroom, or perform other activities of daily living, even with the help of other durable medical equipment such as a cane or walker.
  • You can operate and transition on and off the chair either by yourself or with the help of another who is always with you.
  • Your home doesn’t have any obstacles that would make it difficult to use a wheelchair within (such as small doorways, stairs, etc.).

The next upgrade to a manual wheelchair is a power-operated scooter.

To qualify for this type of electric wheelchair, you must meet all of the requirements above, as well as:

  • You aren’t able to safely operate a manual wheelchair.
  • You must be strong enough to sit upon your own while on the scooter.
  • You must be able to operate the scooter’s controls safely.

If you meet all of the criteria listed above, but you aren’t strong enough to sit up on a scooter by yourself, then you may qualify for a power wheelchair. A power wheelchair is usually needed if your disability limits your arm mobility and your strength to sit up on your own and propel yourself using your arms. A standing power wheelchair is recommended to help relieve pressure sores, edema, and spasticity.

If you qualify for a power wheelchair, your doctor will need to examine you to verify whether you can operate the wheelchair or not. Once your doctor has confirmed that you need a power wheelchair (i.e., that it’s medically necessary), he or she will have to submit documentation explaining to Medicare why you need the upgraded version rather than a manual wheelchair or power scooter.

How Medicare Covers Electric Wheelchairs

If Medicare approves your electric wheelchair, Medicare Part B will cover 80% of the Medicare-approved amount for the wheelchair after your annual deductible is met. Your responsibility is 20% of the cost of the wheelchair unless you have a Medigap plan that covers the Part B coinsurance for you. A secondary insurance generally covers some or all of the costs above the Medicare-approved amount.

A Redman Power Chair is a complex rehabilitation chair. Specifically it is a multi-option group 3 power wheel chair and it is the only power chair that is purchased via Medicare. All other power chairs are capped rental under Medicare guidelines. Note that Medicare will require you to have a face to face encounter with your physician who writes a prescription for the wheelchair.

Electric Wheelchairs That Require Prior Authorization

Medicare uses the term prior authorization when a device, medication, or service needs to be approved through Medicare before it is obtained. All power devices require prior authorization through Medicare, and a Redman Power Chair is no exception; it does indeed require a prior authorization.

As long as your doctor sends detailed information proving that you are in medical need of this wheelchair, then your prior authorization should be approved. However, Medicare may request additional documentation before they make their final decision.

Although the process can be grueling, Medicare will cover electric wheelchairs when medically necessary. Fortunately, Redman Power Chair has their own in-house insurance department and has accepted Medicare since its inception in 1966. Just be patient with the process and supply the necessary documents, and the process should move along smoothly.

Are Motorized Wheelchairs Covered by Insurance?

Are Motorized Wheelchairs Covered by Insurance?

Yes, motorized wheelchairs are covered by insurance. While each person’s situation is different, there are many cases were an insurance provider will cover the cost of motorized or power wheelchair.

Yes, motorized wheelchairs are covered by insurance. While each person’s situation is different, there are many cases were an insurance provider will cover the cost of motorized or power wheelchair.Many wheelchair companies quote standing wheelchairs as experimental, saying the standing function is not a covered benefit. While it may take some time to work with the insurance companies, rest assured that you can obtain a motorized, standing wheelchair through your insurance provider.

Redman Power Chair has an in-house insurance department that coordinates with your benefits to get your provider to purchase your very own power wheelchair.

Redman can help deal with insurance

When you contact our team, well start the process immediately. First we will pre-qualify you by several factors, such as diagnosis, level of mobility and insurance coverage. Next, your personal Redman insurance representative will get your insurance to approve payment, and then we’ll collect payment directly from your insurance provider. After that, you will be on your way to reclaiming your mobility with a brand new power wheelchair.

Rest assured that the insurance team at Redman is one of the most qualified and experienced in the country. The owner and founder of Redman Power Chair actually helped write the first standards for insurance billing of standing power wheelchairs. Therefore, Redman knows how to get insurance to cover this cost.

We do not give up, and neither should you! It’s unfortunate, but frequent, that client’s have medical needs that are not met. Often times they are provided with an inappropriate piece of equipment that does not provide the right benefits to the user.

This is not the case with Redman. If the chair is an appropriate fit for your needs, you can be confident that our insurance specialists will work efficiently and diligently on your behalf.

Call Redman Power Chair at 1-800-727-6684 to get the process started. Your mobility is only one call away.

Other people asked

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Do Insurance Companies Cover Electric Wheelchairs?

Let’s discuss do Insurance Companies cover electric wheelchairs?

Yes, insurance companies do cover and pay for electric wheelchairs and can be coordinated by the Redman Power Chair in house insurance department through your insurance company to help you obtain a power wheelchair at little or no cost. First, we pre-qualify you by diagnosis, level of mobility and insurance coverage.

Next, your personal Redman insurance representative get your insurance to approve payment and collects payment directly from your insurance provider. Call Redman Power Chair at 1-800-727-6684 #3 to get started.

We Do Not Give Up!

It’s unfortunate but frequent that client’s have medical needs that are not met and provided an inappropriate piece of equipment. You should not give up. If the chair is an appropriate fit for your needs our insurance specialists work not only efficiently but without relent on your behalf.

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