Living with multiple sclerosis (MS) often means making adjustments so you can continue to perform your daily tasks and enjoy your usual activities. Many people with MS stay mobile by using a wheelchair.
Wheelchairs can be invaluable for independence, but also expensive. The cost of a wheelchair ranges from several hundred dollars for a manual chair to several thousand — or more — for a high-tech, high-end motorized model.
It’s no wonder many people worry about paying for a wheelchair. Financial assistance is available, though getting it can prove challenging. Depending on the kind of insurance you have, you may need to follow certain rules to get your wheelchair covered. In this article, we’ll dive deeper into how different types of insurance — both government-funded and private plans — and other resources can help reduce wheelchair-related costs.
Medicare is a federal health insurance program designed to cover all U.S. citizens 65 and older, as well as younger people with certain medical conditions, such as a disability. Medicare has four parts:
Wheelchairs are considered a type of durable medical equipment (DME), which is covered under Medicare Part B. To qualify for coverage, you have to meet specific requirements:
Be prepared to do your homework. Be persistent, advised one MyMSTeam member, a self-described “determined disabled veteran who wouldn’t take no for an answer.” “I knew what would work, why it would work, where it could work, and how it could help me,” they wrote. “There are all sorts of questions you must have answers to before you start making calls, kicking the tires, and test-driving. It can be tiring, but you know yourself best.”
Even if you qualify, Medicare won’t pay the entire bill for your wheelchair — it covers 80 percent of the approved amount, after you pay your Part B annual deductible. One MyMSTeam member described receiving this type of coverage for one of their wheelchairs. “I think it was 80/20. It’s best around the house, but it’s heavy and not good to travel unless you have a van and ramp,” they said. This member bought a second wheelchair for about $2,000: “It’s light and folds up for the trunk. It isn’t covered by insurance.”
For many people, Medicare benefits don’t go far enough. Some private insurance companies offer Medicare Advantage plans, which offer benefits beyond those covered by Parts A and B. Part C may include greater coverage for wheelchairs, but be sure to review the plan’s details to determine what is covered and what you will have to pay out of pocket.
Medicare will cover electric wheelchairs and mobility scooters only if a person meets all the above requirements and can show (usually with a doctor’s note or prescription) that they cannot operate a manual wheelchair. Power wheelchairs with certain features, such as a particular type of seat or back, require prior authorization. This means the insurance plan will review your request and decide if they’ll approve coverage.
Traditional Medicare generally covers a wheelchair and a lift that helps you get into it from a bed or chair, but ramps must be paid for out of pocket. Medicare Advantage or another insurance plan might offer the extra coverage.
Medicaid, another government-sponsored program, provides insurance for particular groups of people, such as those with a disability or low income. In most states, if you are receiving government disability benefits under the Supplemental Security Income (SSI) program, you automatically qualify for Medicaid.
Like Medicare, Medicaid generally covers durable medical equipment, including a wheelchair, if it is prescribed by a doctor. Generally, Medicaid — also like Medicare — covers power wheelchairs only if you can’t operate a regular wheelchair.
Medicaid coverage for home modifications, such as ramps and wheelchair accessories, varies among states. This is because Medicaid is funded by the federal government but managed by states. Thus, states are free to decide what kind of DME — and how much of the cost — they will cover. It’s important to check with your state’s Medicaid agency to learn what is covered and the requirements you must meet.
Private insurance plans are not funded by the government and are instead offered by companies such as Blue Cross Blue Shield, Humana, UnitedHealthcare, and many others.
People who have private health insurance, either provided by an employer or purchased themselves, usually pay a monthly premium for that coverage. Insurance companies also set a deductible and copayments — amounts you must pay before a plan begins to pick up costs for covered services, supplies, and equipment. Insurance plans differ regarding what kind of wheelchairs they will cover and how much they will pay. It’s essential to review your plan’s benefits and coverage details.
Private insurance plans often also require prior authorization. The insurance company will manually review your wheelchair request and decide if it will be approved. If you are denied coverage, you have a right to appeal that decision.
Insurance may cover some or all of the costs related to buying a wheelchair, but it’s not always enough. Although the rate of uninsured people in the U.S. is at an all-time low, about 8 percent of U.S. children and adults have no insurance. Fortunately, other financial assistance programs and resources can help with the cost of wheelchairs and other durable medical equipment.
Some nonprofit organizations provide guidance and financial assistance for people with MS who need mobility equipment. For example, MS Navigators with the National Multiple Sclerosis Society can help you search for an affordable, appropriate wheelchair and sources of financial help. In addition, the Multiple Sclerosis Foundation’s Assistive Technology Program may help find and fund devices — such as a wheelchair — that you need for daily life and other activities.
Many states have programs that give financial assistance to people with disabilities. To learn what your state offers, you can start with the list of health departments in states and territories from the Centers for Disease Control and Prevention (CDC).
States also receive grants under the Assistive Technology (AT) Act of 2004, which in June will become effective as the 21st Century Assistive Technology Act. The act aims to promote access to AT devices and services, including wheelchairs. The Assistive Technology Act Technical Assistance Training Center provides a list of state AT programs, which may help you save money on a wheelchair.
Additionally, some cities and counties may offer grants for home modifications and wheelchair ramps. Check your local government’s health department website for more information on any available financial assistance.
If you’ve had to stop working because of your MS, you might get help with wheelchair costs through Supplemental Security Income and Social Security Disability Insurance. These programs provide financial assistance for living expenses, including the cost of mobility equipment, for people who are no longer able to work due to their medical condition. To be eligible, an individual must not only have a qualifying medical condition but also have paid enough in Social Security taxes from their past income.
Often, community resources can help lower wheelchair-related expenses for people with MS. For example, some local organizations offer free or low-cost home-modification services or assistance with grants or other sources of financial aid.
Getting financial assistance for wheelchairs and other DME can be a challenge for people living with MS, but help is available. It’s essential to research all available options and resources to find the best solution for your needs. The effort is worth it, as one member expressed in reply to another who’d just received a wheelchair from their insurance company: “Congrats! I know that free moment of getting out of bed and cruising in that wheelchair!”
MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 197,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.
Do you have questions about insurance or getting financial help for a wheelchair? Have you found any resources for getting the equipment you need for living with MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.