Paying for a Wheelchair
Insurance Coverage of Wheelchairs, Power Wheelchairs & Scooters
Paying for durable medical equipment can be a trying process and it can be difficult to determine how to pay for a wheelchair. No matter your need, this page will help you learn the basics about funding the purchase of your new Broda equipment.
Broda’s wheelchairs and chairs are classified as durable medical equipment (DME) or home medical equipment (HME). These types of purchases are often covered by insurance or other funding assistance. These reimbursement processes are often complex, and many people have difficulty understanding and navigating the payment and procurement processes.
So, does Medicare, Medicaid or other public government insurance cover the cost of manual wheelchairs? This is one of the most common questions we receive, and the short answer is: Yes!
You can buy or rent Broda’s wheelchairs from our global network of local, trusted distribution partners. Payment can be made with cash, credit or by utilizing public, governmental, or other privately managed care insurance programs:
- Medicaid (US)
- Medicare (US)
- Assisted Device Program (CA-ON)
- Other Private Health Insurance
Will One of These Programs Cover the Cost of a Broda Wheelchair?
Whether or not a Broda wheelchair will be covered by any of these programs is a complicated question. It depends on the occupant’s needs, the type of wheelchair prescribed, and program eligibility based on financial, geographic, and other qualifying factors.
Often, multiple sources of payment are utilized together to purchase wheelchairs, including financial assistance and out-of-pocket payments.
Paying for a wheelchair can be quite complicated, so Broda is here to help. We have over four decades of seating and positioning experience and all our products are backed by the best frame warranty in the industry. Broda’s long-lasting, reliable equipment helps users maintain mobility and the ability to perform activities of daily living (ADLs).
Step 1: Demonstrate Medical Necessity
In order for most of these public or private insurance programs to pay for a manual wheelchair or seating equipment, a senior or user must have a condition that prevents them from moving around in their home and completing their activities of daily living. Their level of immobility must require more than the use of a cane or walker. The wheelchair must also be medically necessary for daily life inside the home, and not just for temporary trips or outings.
For these programs to pay for a powered or electric wheelchair (sometimes called a scooter), the individual must have the same needs as for a manual wheelchair, but they cannot have the physical strength to self-propel and operate it. In addition, they must demonstrate they can control the powered device without hurting themselves or those around them. Even in the cases a user primarily occupies a power wheelchair or scooter, some programs will also cover a backup manual wheelchair as well. Whether or not a manual wheelchair’s purchase is covered, it is recommended to have a manual wheelchair on hand in case of battery failure, maintenance or other common issues with power chairs.
Step 2: Document Medical Necessity
Many types of medical professionals have the knowledge to evaluate an individual’s mobility and recommend the proper equipment needed to provide a better quality of life. Doctors (MD/DO), physician assistants (PA), occupational therapists (OT/DOT), physical therapists (PT/PTA), hospital discharge planners, home health nurses, nurse practitioners (NP), and assisted technology professionals (ATP) can all prescribe or recommend the right wheelchair for you or a loved one.
Clinicians use many mobility assessment tools and protocols utilized to properly evaluate and document the need for a wheelchair. These can be conducted in–home, inside long-term care facilities, or by appointment at a seating clinic. The evaluation process should be a collaboration between the healthcare professional, the caregiver, and the patient. Caregivers can provide excellent observational knowledge of the patient’s condition, living environment, and behavioral state in an unbiased way, especially if the patient has cognitive difficulties.
Documentation of the medical necessity for the wheelchair is then formalized through a written order or prescription from a doctor or clinician. The prescription will clearly state the medical reason for the need and the type of wheelchair that is required. This is not always necessary for durable medical equipment, like wheelchairs, but depends on the jurisdiction and insurance program. A good guideline is the higher degree of medical authority (MD, DOT, DPT, etc.), the better chance the insurance program will accept the order and pay for the equipment.
Private and public insurance programs will then process the claim and reimbursement amounts as outlined by their regulations.
Step 3: Ask For Help with the Payment Process
Regardless, in most cases getting insurance to pay or contribute to the purchase of medical equipment is not an easy task. If you have questions about how paying for a wheelchair will work for you, contact your insurance carrier for more information. When you are ready to order, Broda is here to help!