Does Medicare Pay for Wheelchairs?
Before making a decision on purchasing or requesting a wheelchair through insurance, there are some important questions that you should ask before starting this process. The question that is first and foremost on most people’s mind is, “Does Medicare pay for wheelchairs?” The short answer to this questions is, “Yes.” Medicare will cover 80% of the cost of a wheelchair, as long as it has been documented by a medical team that the client meets certain qualifications. Some secondary insurance policies will cover the remaining 20%. The criteria vary depending on the type of wheelchair that someone is looking to receive, and many consumers are not aware of their options when it comes to wheelchairs. It is beyond the scope of this blog to go into extensive detail, but here are the basics.
Medicare Qualifications for a Wheelchair
To qualify for any wheelchair, it must be documented by a medical provider that the wheelchair is required to perform self-care tasks in the home due to a specified medical condition. It must also be documented that a person cannot sufficiently use a can or walker to accomplish these tasks. Medicare does not cover the use of a wheelchair to take someone to an appointment, or for a stroll in the community. While this function is essential for daily living, it is not a criteria that is covered by Medicare, if this is the main reason you require a wheelchair. The reason must directly be related to self-care and the chair must be required for use in the home. The qualifications get more specific as the complexity of the wheelchair increases. Here are some general guidelines (full guidelines are available on the Medicare website).
Types of Manual Wheelchairs
Standard Wheelchair: This is the base model of most all wheelchairs. This wheelchair can weigh anywhere from 35-45 pounds.
Lightweight Wheelchair: This wheelchair weighs slightly less than a standard wheelchair at 30-35 pounds, making it easier for someone to propel themselves. It must be documented that the client is independent for self-propulsion in the lightweight wheelchair for at least 150 feet (meaning they can wheel themselves around using their hands and/or feet). Medicare will not pay for a lightweight wheelchair if the client needs help with wheeling the chair.
Lightweight High Strength: This wheelchair weighs about the same as a lightweight wheelchair, but is made of a more durable material. This option is only available to clients who are independent for mobility in the wheelchair and who require customization to the frame of the wheelchair that is not available on other models.
There are other classes of wheelchairs including ultralight wheelchairs and tilt-in-space wheelchairs, however these require a specialized evaluation by a professional called an Assistive Technology Professional (ATP), as well as an occupational therapist of physical therapist.
Should I Use My Medicare Benefits to Pay for a Wheelchair?
This is a great question! While there is no universal answer, I can give some general advice. If someone is looking for a wheelchair to have for occasional use, or to have “just in case” they need it. I would not recommend having Medicare pay for a wheelchair. I would recommend saving your Medicare benefits for a time when you or your loved one needs to use the wheelchair consistently in the home. Here is why:
If you get a “just in case” wheelchair, the wheelchair will not have any custom features, as these features are driven by diagnosis and medical necessity. If circumstances change after a few months and the client now needs to consistently use a wheelchair, you may or may not be able to upgrade the features of the wheelchair.
Once Medicare pays for a wheelchair, this is the wheelchair that you will need to use for the next 5 years. There are cases where you can “upgrade” the wheelchair if the client’s medical condition changes, but some features cannot be changed. You don’t want to be “stuck” with a chair that does not meet your needs.
If you are looking for a wheelchair to use for those “just in case” times, a transport chair may be a better fit. They are lightweight and designed for someone to push the client in the chair to go out and about in the community. They are also easier and lighter to fold up and put in a car than traditional wheelchairs.
If you or your loved one is at the point where they need the wheelchair for consistent use in the home, then you should absolutely pursue having an occupational therapist or physical therapist provide an assessment for a custom wheelchair. They will be able to help decide which type of chair will best meet your needs and ensure that the client is properly measured so that the chair will fit properly.
What if I Want to Buy a Wheelchair on my Own?
Great question! If you are looking for that “just in case” chair, you may want to purchase a wheelchair on your own. This is an option if you do not meet Medicare requirements, or you just want to have a spare chair. There are several models and options of wheelchairs that are commercially available. You can go check out what’s in stock at a local durable medical equipment vendor, or your can take a look online. Here are some options for my most frequently-utilized chairs that are available online. Some of these are transport chairs, and some are standard wheelchairs. For a more detailed description on the differences between the two, take a look at our blog, “What is the Difference between a Transport Chair and a Wheelchair?”. Here we go:
*Disclaimer: This blog contains links to affiliate websites. When you click on and/or purchase any items using these links, we may receive a small commission at no additional cost to you. Our use of affiliate links does not influence the products, services and information we share with you. My goal is to provide you with education to help you make informed decisions. These links allow me to reference the specific products that I have clinical experience using in the field.
1) Basic Standard Wheelchair: Drive Medical Ultra Lightweight Wheelchair
There is nothing fancy about this model. It covers the basics and also has flip-away armrests. This will meet the needs of most people who just need a basic option. This standard model is fairly lightweight at about 40 pounds and costs around $140.
2) Basic Transport Wheelchair: Drive Medical Lightweight Expedition Folding Transport Wheelchair
This chair is designed for a caregiver to push a client in, not for the client to wheel themselves. There is nothing fancy about this transport chair, but it covers the basics at a low cost of approximately $200. It has larger 12-inch back wheels and hand brakes underneath the push-handles for easier handling on behalf of the caregiver.
3) Hybrid Wheelchair: Medline Hybrid 2 Transport Wheelchair
This is a transport chair and a standard wheelchair in one. It has four small 9-inch wheels to function as a transport chair, but it also has 2 large side wheels that can be easily removed and inserted with an easy push of a button. The wheels are typically removed when you store it in the car (this just makes the chair lighter to pick up), but then you can snap the large wheels back on when you get to where you are going so the client can wheel themselves. If you keep the large wheels off, it will function like a standard transport chair, using the 4 small wheels. (Disclaimer, if you click this link, you will need to scroll down to the description to see better pictures). This chair comes at a price of around $780.
4) “Modern and Stylish” Wheelchair: Strongback Wheelchair
This chair is not actually a transport chair. It is a super lightweight wheelchair (24.8 pounds) that is a light as a transport chair. My clients like it because it looks modern and stylish, and allows them to wheel themselves. The seat and back are also ergonomically designed and are very comfortable. The wheels can easily be removed to make it lighter to lift in and out of the car. This chair weighs a mere 24.8 pounds. Because of its advanced design, this chair comes with a higher price tag, but my clients have always been happy with the comfort and versatility of this chair. This chair rings in at closer to $900.
What if I Have Questions?
There are many places to look for assistance. Your primary care physician may be a good place to start. They will need to write an order for a wheelchair in order for insurance to cover the cost. They may also be able to connect you with a therapist to help with the process of measuring for the chair and discussing options. You can also call a local medical supply vendor who can help you understand your options and the process for getting a wheelchair. You can also go to the Medicare website to learn about qualifications for specific wheelchairs and coverage.
For more information, please check out YouTube channel, and our other Blog posts including, “What is the Difference between a Transport Chair and a Wheelchair?” and, “Does Medicare Pay for Transport Chairs?” Also consider our book, “A Therapist’s Guide to Caregiving” for a detailed guide on how to help your loved one with mobility and self-care. Also, feel free to check out our full video training course for detailed video instruction.
A Therapist’s Guide to Caregiving
The book includes 170 pages of full-color, step-by step instructions, to provide you with all the skills you need to provide safe, thorough, and compassionate care at home.
This is your comprehensive guide to giving you with the skills you need to provide safe, effective, and compassionate care to family members, friends or clients in the home. This course includes 6 hours of instructional video covering client basic adaptive equipment, functional mobility, lifting techniques, transfers, self-care skills, bed level care, use of client lifts and transfer devices, and managing falls. Click "Preview Caregiver Course" below to preview the lessons and descriptions.
