Understanding Insurance Coverage For Wheelchairs: A Guide To Billing And Costs

The cost of a wheelchair can vary widely, from $3,000 to $5,000 for a manual wheelchair, to tens of thousands of dollars for a motorized wheelchair. Insurance coverage for wheelchairs also varies, with some government plans offering better coverage than private insurance. In the US, Medicare Part B covers wheelchairs and scooters as durable medical equipment (DME) that a doctor prescribes for use in the home. Medicare typically pays 80% of the Medicare-approved amount, while the beneficiary pays the remaining 20% after meeting the Part B deductible. Private insurance companies may also cover the cost of a wheelchair, but the coverage amount and requirements can differ. Additionally, individuals with accessible or wheelchair-adapted vehicles can insure them like standard cars, but they may need to disclose modifications to ensure coverage.

Medicare Part B coverage

Medicare Part B covers wheelchairs and power-operated vehicles (scooters) as durable medical equipment (DME) that your doctor prescribes for use in your home. It covers 80% of allowable charges for a wheelchair, and you will be responsible for the remaining 20% of the cost, along with your annual Medicare premiums.

To qualify for Medicare Part B coverage for a wheelchair, you must meet certain pre-conditions. Your doctor must confirm that you have limited mobility and that a wheelchair is medically necessary to manage your condition. They must also confirm that you are capable of safely operating the type of equipment you're requesting, or that you have someone in your home who can always help you use the wheelchair.

Your doctor must also explain in writing that you need the wheelchair to get around in your home and that a walker or cane will not provide the mobility you need. They must also describe the reason you need the wheelchair, for example, if you have difficulty getting out of bed, getting dressed, or going to the bathroom.

Medicare Part B covers three main types of wheelchairs: standard manual wheelchairs, power scooters, and electric wheelchairs. The type of wheelchair covered depends on your physical condition and your doctor's recommendations. If you have enough upper body strength to safely manage a manual wheelchair, or have someone at home who can push you, your doctor might order a manual wheelchair.

If you lack upper body strength to operate a manual wheelchair, but are able to sit up on your own, a power scooter may be more appropriate. Power scooters are designed to travel long distances outdoors and are particularly suitable for hilly or rugged areas.

If you lack the upper body strength to sit in a power scooter or propel yourself in a manual wheelchair, your doctor may order an electric wheelchair, which may offer you more independence and operate smoothly indoors and outdoors, especially on flat terrain.

Medicare Part B will cover the cost of renting or purchasing a wheelchair if your mobility issues are temporary. You can consult a doctor to determine the out-of-pocket cost of a wheelchair or scooter, which will depend on factors such as your other health insurance, how much the doctor charges, and the type of facility.

Medicare Part B also covers the cost of repairing or replacing a wheelchair. For example, Medicare covers wheelchair repairs if you get the services from a Medicare-approved supplier. If you rent your wheelchair, your Medicare-approved supplier will perform the necessary repair services, and Medicare will cover the cost of loaned equipment during the repair period.

Private insurance coverage

It is important to contact your insurance company to understand your specific coverage. Some private insurance plans may cover the cost of a wheelchair if it is deemed medically necessary by a doctor. The process typically involves obtaining a written prescription or order from your doctor and submitting it to the insurance company for approval. The doctor's prescription should outline the medical need for the wheelchair and confirm that it will be used in the home.

Private insurance companies usually have specific requirements that must be met to qualify for wheelchair coverage. These requirements often align with those of Medicare, which include having a health condition that causes difficulty moving around in your home and being unable to perform activities of daily living, even with the assistance of a cane, crutch, or walker. Additionally, the beneficiary should be able to safely operate the wheelchair or have someone available to help them use it.

It is worth noting that private insurance plans may have different reimbursement rates for wheelchairs, and these rates are individually negotiated. The reimbursement amount may depend on the specific procedure codes associated with the wheelchair and any medically necessary accessories or options billed separately. In some cases, private insurance coverage for wheelchairs may be available on a shorter cycle than Medicare, especially when medically necessary changes are required.

Cost of wheelchairs

The cost of a wheelchair varies depending on the type, brand, and features required, as well as the user's location and insurance coverage.

Manual Wheelchairs

Manual wheelchairs are generally more affordable than powered options and can range from $3,000 to $5,000. However, this price can vary depending on the specific features and functionality included.

Powered Wheelchairs

Powered wheelchairs, also known as motorized or power-operated wheelchairs, are more expensive than manual ones. They can cost tens of thousands of dollars, with prices ranging from $17,000 to $50,000 for advanced models.

Insurance Coverage

Insurance coverage for wheelchairs can vary significantly across different countries, states, and insurance providers. In the United States, federal government-funded health insurance for the elderly and disabled, such as Medicare, may reimburse between $1,567 and $2,458 for an "active ultra-light" wheelchair. Medicare typically covers 80% of the Medicare-approved amount, leaving the patient responsible for a 20% copayment. Private insurance companies in the US often have individually negotiated reimbursement rates that may be slightly higher than Medicare's rates.

In Canada, the government will fund up to $3,900 of approved chairs and components, with clients contributing $500 and any additional costs above $3,900.

In Greece, insurance pays approximately 800 euros for a new wheelchair every four years, which may not cover the full cost of a high-quality chair.

In the Netherlands, wheelchairs are provided by the municipality instead of insurance companies. Individuals receive the cheapest option that meets their needs, and it may be a second-hand model.

Additional Considerations

It is important to note that insurance coverage for wheelchairs often comes with specific requirements and restrictions. For example, some insurance plans may have annual dollar caps on medical devices, limiting the amount they will reimburse for a wheelchair. Additionally, certain insurance plans may only cover wheelchairs for home use and not for activities outside the home, such as work or running errands.

When considering the cost of a wheelchair, it is essential to review your insurance plan's coverage, exclusions, and any prior authorization or documentation requirements.

Insurance fraud

One common form of wheelchair insurance fraud involves the submission of false or inflated claims by medical equipment companies. These companies may offer expensive power wheelchairs and scooters to individuals who do not actually need them. They may even go as far as to bribe or pressure doctors into writing prescriptions for their patients, whether necessary or not. In some cases, they may bill Medicare for equipment that was never delivered or provided to the patient. This type of fraud takes advantage of the system's vulnerabilities and results in substantial financial losses for taxpayers and insurance providers.

Another form of fraud involves individuals who misrepresent their need for a wheelchair or conceal relevant information. For example, an individual may hide their condition from their insurer to obtain a lower premium or fail to disclose vehicle modifications made to accommodate their wheelchair. This type of fraud can have legal implications and is considered a serious offence.

To combat wheelchair insurance fraud, Medicare has implemented various measures, including competitive bidding processes for lowering equipment costs, requiring wheelchairs to be rented before purchase, and reviewing all wheelchair bills before reimbursement in certain states. These efforts have helped curb fraudulent activities and protect taxpayer money.

Additionally, individuals can play a role in preventing fraud by being vigilant and reporting any suspicious activities or offers. By working together, we can help ensure that those who truly need wheelchairs receive the necessary assistance without being taken advantage of by fraudulent schemes.

Insurance for wheelchair-adapted vehicles

If you have a disability and use a wheelchair-adapted vehicle, you can insure it like any other car. However, you may need to disclose the modifications made to your vehicle to your insurer to ensure that they are covered. While your disability status alone cannot increase your insurance rate or result in denial of insurance, certain conditions or symptoms that affect your driving ability may impact your premium. It is important to be transparent about any known conditions and vehicle modifications to ensure proper coverage and avoid legal implications in the event of an accident.

When insuring a wheelchair-accessible vehicle, consider the following:

• Disclosing Vehicle Modifications: Be honest and declare all modifications, such as hand controls, amputee rings, pedal extenders, siren detectors, wheelchair ramps, and wheelchair-adjustable seats and seatbelts. This ensures that these adaptations are covered in the event of an accident or damage.
• Certified Installation: Ensure that all modifications are installed by a certified technician. Improper installation may result in insurance not covering the equipment.
• Equipment Coverage: Verify that your insurance policy covers any specialised equipment, including wheelchairs, both inside and outside your vehicle. Consider add-ons or equipment coverage policies if necessary.
• Transparency About Disability: Disclose your specific disability to address any concerns about your risk level when driving. This transparency can help ensure fair rates and coverage.
• Ask Questions: Don't hesitate to ask your insurer questions to make an informed decision. Understanding your policy and coverage options is essential for choosing the right insurance plan.
• Compare Quotes: Shop around and compare quotes from multiple insurance companies. Specialist insurers and mainstream insurance companies offer coverage for wheelchair-accessible vehicles, and rates can vary.
• Esurance: Offers full coverage modified car insurance at around $333/month.
• Hagerty and Safeco: May offer more competitive rates compared to Esurance.
• Fish Insurance: A specialist WAV insurance company providing bespoke insurance for wheelchair-accessible vehicles.
• Chartwell Insurance: Offers cover for wheelchair-accessible and adapted vehicles.
• Adrian Flux Insurance: Provides a range of policies for wheelchair-accessible and disabled driver vehicles, including features like like-for-like cover on adaptations and modifications, cover for manual wheelchairs in the vehicle, and cover for young disabled drivers from 16 upwards.
• Acorn Insurance: Covers adapted vehicles.
• Be Wiser Insurance: Provides insurance quotations for wheelchair-accessible vehicles.
• Go Compare Insurance: Offers insurance quotations for wheelchair-accessible vehicles.
• Towergate Insurance: Has a specialist team for mobility and adapted vehicle insurance.
• Mobility Insure: A broker specialising in insurance cover for disabled individuals.
• Quote Rack Insurance: A specialist insurer for wheelchair-accessible and adapted vehicles.

Remember, it is crucial to be transparent about your disability and vehicle modifications to ensure proper coverage and compliance with legal requirements. Shopping around and comparing quotes can help you find the most suitable insurance plan for your wheelchair-accessible vehicle at a competitive rate.

Frequently asked questions