Medicaid Wheelchair Overview – Does Medicaid Cover Motorized Wheelchairs and Scooters?
Many disabled people are in need wheelchairs in America and simply can’t afford them. One way to obtain a wheelchair, powerchair or scooter is through the Medicare/Medicaid insurance programs. It is possible to get a wheelchair through a combination of coverage by Medicare and Medicaid at no cost to the recipient, it is not guaranteed. Medicaid wheelchairs are available if you know how to get them.
The Medicaid Program:
Medicaid is a government subsidized healthcare program designed to assist people who fall into the low income category to receive adequate healthcare by providing supplemental insurance coverage to Medicare, the primary government subsidized insurer. Within both the Medicare and Medicaid programs are sub-programs with coverage for durable medical equipment. Wheelchairs, power chairs and scooters are considered durable medical equipment and therefore qualify for coverage most of the time.
How it Works:
Most people, who have supplemental Medicaid insurance, also have primary coverage under Medicare. Medicare will generally cover 80% of the cost of a medically necessary wheelchair, if the Medicare recipient has Part B coverage, which covers outpatient services including doctors’ visits and durable medical equipment, and has undergone a full physical examination by an approved physician. Conditions that warrant a medically necessary wheelchair include: spinal, brain or muscular conditions that prohibit the normal use of the patient’s legs, an inability to build upper arm strength due to spinal, brain or muscular conditions, or any other condition that would render a patient bedridden when not in a wheelchair.
Whether or not the supplemental Medicaid coverage will pick up the tab for the remaining 20% will depend completely upon an independent review by Medicaid. Medicaid is under no obligation to approve coverage, even if Medicare has.
There is no guarantee of a free Medicaid wheelchair, power chair or scooter and those companies who make such promises should be regarded with caution. Since 2003, Medicare and Medicaid have imposed much stricter guidelines in determining who qualifies for medically necessary wheelchairs and the amounts they will cover for such equipment after being the victim of several unscrupulous companies who bilked the insurers for thousands of dollars in fraudulent claims and astronomical prices. Medicaid recipients who have been deemed disabled and requiring a wheelchair should work closely with both Medicare and Medicaid to understand what costs will be covered and what limits will be imposed when looking for a wheelchair as well as whether or not their condition falls under a covered condition category.