Ask The Expert - Young Medical Q & A

Question: Will Medicare Insurance provide me a wheelchair to use "outside" my home?
Answer: Medicare has some very clear guidelines about buying wheelchairs. The wheelchair must be required in order to provide a safe and functional means to get around inside the house. Medicare is only interested in funding wheelchairs for use within the home. Therefore all documentation, the letters of justification and the Certificates of Medical Necessity (CMN), must support and explain the need for the wheelchair within the home. The fact that it can also be used outside of the house is incidental and is actually irrelevant. The mobility device, whether motorized or manual, must be required for moving around within the home. The question Medicare asks on the CMN is: "Does the patient require and use the w/c to get around the home?" If Medicare is your primary health insurance then there are some additional things that you should know if you want Medicare to pay for your wheelchair. Medicare has strict rules when it comes to payment for durable medical equipment. They have a list of authorized or "pre-approved" wheelchairs. These wheelchairs appear on the HCPCS (pronounced "HicPics") list and are the only ones for which Medicare will pay. However, most brands of wheelchairs fit into one of their categories. NOTE: Medicare pays 80% of the cost of a wheelchair and either you or your secondary insurance pays the other 20%.