Will Health Insurance Pay for Wheelchairs?

From illnesses that affect the musculoskeletal system to injuries that have affected the spinal cord, there are a variety of maladies that can impede a person’s ability to walk.

Whether your ability to walk has been affected on a temporary or permanent basis, you’re going to need a wheelchair to get around. Without one, you would be confined to one space and would have to rely on the help of others to move from one location to another. Not only would this affect your overall health and well-being, but it would also affect those who you rely on for assistance. If you have recently learned that you are going to require a wheelchair, however, you’ve probably learned how expensive this type of assistive medical equipment can be. Prices can range from a few hundred dollars for manual chairs, to a few thousand dollars or more for motorized devices.

If you do need a wheelchair and you have insurance, you’re probably wondering if the company that issues your policy will cover the cost of the equipment. Read on to find out more about wheelchairs and insurance coverage.

Insurance Coverage and Wheelchairs

Many people who have health insurance automatically assume that any type of medical care they require will be covered; however, that is not always the case. The type of insurance you have does have a direct impact on what is and what isn’t covered.

In regard to wheelchairs, generally, most health insurers will cover the expense; but, it’s always in your best interest to contact your carrier to find out for sure. In addition to finding out if your plan does include wheelchair coverage, you’re also going to want to find out the following:

• What type of wheelchair is covered; some carriers will only cover manual devices, while others may cover motorized wheelchairs, but only specific kinds.
• If there are any requirements you will need to meet in order to ensure you receive coverage. For example, many insurance companies will require the doctor who is providing you with treatment to submit a written order that states there is a medical need for a wheelchair. Furthermore, proper documentation about your health condition may need to be submitted.
• If your plan does cover wheelchair expenses, find out how much of the cost you will be responsible for covering out of your own pocket. For example, if your health insurance is provided by Medicare Part B, you would be responsible for 20% of the amount that Medicare approves after you meet your annual deductible; once you met your deductible, Medicare would then cover 80% of your wheelchair. If you have a private health insurance plan or you are covered under your insurer, the stipulations will differ. Therefore, it’s always important that you check with your carrier before you attempt to get a wheelchair, otherwise, you may be hit with unexpected expenses.
• Additionally, you should find out if you have to secure the wheelchair from a specific location. Some policies require wheelchairs to be purchased or rented via specific medical supply companies or hospitals.
• Lastly, once you find out about your insurer’s rules regarding wheelchairs, it’s important that you find out if the medical supply company accepts your insurance. Just like doctors and health facilities, not all medical supply companies accept all types of insurance.

What If You Don’t Have Insurance?

Just like anything else related to health care, the cost of a wheelchair, if you aren’t insured, can be exorbitant; therefore, if you aren’t insured and you require this type of assistive device, it is in your best interest to see about getting coverage.

You can purchase a private plan through the Insurance Marketplace. However, if this is an option you are going to pursue, it’s important that you understand you will have to purchase your policy during the open enrollment period (which usually begins every November) unless you qualify for an exception that would allow you to purchase a policy outside of the open enrollment period.

You could also find out if your employer offers an insurance plan and seek coverage through them. But again, it is likely that you would have to apply during your employer’s open enrollment period; furthermore, you will likely have to meet certain qualifications to receive coverage. For example, you may be required to work for the company for a specific amount of time before you would be eligible for the coverage they provide.

The Bottom Line

Wheelchairs can be life-changing assistive devices, but they can also be quite expensive. Insurance can help to offset the out-of-pocket costs but do make sure that you check with your carrier so you are fully aware of any rules that apply.