Does Medicaid Cover Electric Wheelchairs?
- Does Medicaid cover electric wheelchairs? Discover how funding for electric wheelchairs works through Medicaid and Medicare and where to get a free wheelchair.
If you have a medical condition that makes it hard to move around your home or local area, an electric wheelchair can significantly improve your quality of life and independence. However, electric wheelchairs are expensive, so it's important to consider how to fund them.
So, does Medicaid cover electric wheelchairs? Below, you can find out if Medicaid and Medicare cover electric wheelchairs, who's eligible and how to get a free wheelchair if you don't qualify.
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Does Medicaid Cover Electric Wheelchairs?
Whether Medicaid covers electric wheelchairs varies by state, and many states fund electric wheelchairs under durable medical equipment (DME) coverage. Some states cover the full cost of an electric wheelchair for eligible Medicaid beneficiaries while others cover part of the cost. You can find out if your state's Medicaid plan covers electric wheelchairs by contacting your state's Medicaid Agency.
Medicaid Electric Wheelchair Eligibility
You'll need to be eligible for Medicaid coverage before you can receive funding for an electric wheelchair through Medicaid. Federal law sets mandatory eligibility groups, which means that all states must legally cover residents belonging to certain populations. For example, all states must provide Medicaid coverage to low-income families and people receiving Supplemental Security Income (SSI).
In 2010, the Affordable Care Act (ACA) was introduced to allow states to voluntarily expand Medicaid benefits to people who would not previously have been eligible. Following the act, all states expanded Medicaid to children from families living on a minimum of 133% of the federal poverty level (FPL). Many states expanded benefits to adults in the same circumstances.
To qualify for Medicaid, you'll usually need to meet certain financial eligibility requirements and be a resident in the state you claim. Some states extend coverage to individuals deemed to be "medically needy" who would not otherwise qualify.
If you're a Medicaid enrollee, you may be entitled to funding for an electric wheelchair if your doctor verifies that it's medically necessary. Some states set additional eligibility requirements for electric wheelchairs through Medicaid. For example, they may restrict funding for certain accessories or require some beneficiaries to complete a course of physical therapy beforehand.
Does Medicare Cover Electric Wheelchairs?
Medicare Part B may cover DME if it's medically necessary, including electric wheelchairs, and you may require prior authorization. It doesn't usually cover accessories for wheelchair users such as ramps.
If you're eligible, Medicare pays up to 80% of the Medicare-approved amount, and you are liable for the remaining 20%. You may also be eligible if you have a Medicare Advantage Plan, and some plans cover a wider range of accessories than Original Medicare.
To qualify for funding for an electric wheelchair through Medicare Part B, you must satisfy all the following criteria.
- A manual wheelchair is unsuitable for your home, or you can't support yourself in or control a power scooter.
- Your health condition significantly restricts your movements around your home.
- You can operate and get in and out of your wheelchair or have an assistant available to help and keep you safe.
- Your doctor and wheelchair provider are Medicare enrollees.
- Your electric wheelchair is suitable and safe to use inside your home.
Medicare won't cover an electric wheelchair unless your doctor has examined you face to face and checked that an electric wheelchair is a suitable option for you. They will need to verify that an electric wheelchair is medically necessary and that you can use it safely.
How Can I Get a Free Electric Wheelchair?
You may be entitled to a free electric wheelchair if you are a Medicaid enrollee and your state covers it. You may also receive funding for most of the cost of your electric wheelchair if you're a Medicare beneficiary and it's a safe and necessary option. Some private health care insurance plans also cover electric wheelchairs.
If you're ineligible for an electric wheelchair through Medicaid, Medicare or your private insurer, you may be able to get a free electric wheelchair through a nonprofit organization. Several regional organizations provide subsidized or free refurbished wheelchairs to local people in need. Your doctor or a local support group or forum can help you find a local organization that provides donated wheelchairs to people who need them.
How Much Does an Electric Wheelchair Cost?
How much an electric wheelchair costs varies widely depending on the brand and model, and you'll generally have to pay more if you want an adjustable or customized wheelchair or the most up-to-date features.
Generally, you should expect to pay somewhere between $2,000 and $6,000 for a non-customized electric wheelchair. However, customized models can cost between $12,000 and $50,000.
