Can You Get a Wheelchair Through Medicare?
Does Medicare cover wheelchairs? Get clear answers on eligibility, the process to obtain one, and understanding your costs.
Medicare, the federal health insurance program for individuals aged 65 or older and certain younger people with disabilities, helps beneficiaries access necessary healthcare services and equipment. The program covers a range of medical needs, including durable medical equipment (DME) like wheelchairs, under specific conditions.
Medicare Coverage for Wheelchairs
Medicare Part B, which is medical insurance, covers durable medical equipment (DME), including wheelchairs. DME is defined as equipment that can withstand repeated use, serves a medical purpose, is not generally useful to someone without an illness or injury, is appropriate for home use, and is expected to last at least three years. This ensures the equipment is necessary for a beneficiary’s medical care.
Medicare covers various types of wheelchairs, such as manual wheelchairs, power-operated vehicles (scooters), or power wheelchairs, depending on medical needs. Coverage for these devices is contingent upon them being medically necessary. Medical necessity means the equipment is required to diagnose or treat an illness, injury, condition, or its symptoms, meeting accepted standards of medicine.
Meeting Eligibility Requirements
To qualify for Medicare coverage of a wheelchair, a beneficiary must meet specific eligibility requirements centered on medical necessity. A key requirement is a medical condition that significantly limits their ability to move around their home. This limitation means they cannot perform daily activities such as bathing, dressing, or using the bathroom, even with less supportive mobility aids like a cane or walker.
The treating physician plays a central role in establishing medical necessity. The physician must be enrolled in Medicare and conduct an in-person examination. During this visit, the doctor assesses mobility needs and determines if a wheelchair is the appropriate solution. The physician must then write a detailed prescription or order for the wheelchair, specifying the type needed and documenting the medical necessity, including the beneficiary’s medical condition, functional limitations, and why it is required for home use.
The “face-to-face” requirement ensures the physician has personally evaluated the beneficiary’s condition. For certain powered wheelchairs or scooters, this meeting should occur no more than 45 days before the order is written. The wheelchair must primarily be for use in the beneficiary’s home, though it can also be used outside. If the beneficiary resides in a long-term care facility not providing primarily skilled care or rehabilitation, that facility can be considered their home for coverage.
Steps to Obtain a Wheelchair
Once a physician determines medical necessity and provides a prescription, the next step involves working with a Medicare-approved durable medical equipment (DME) supplier. Find a supplier enrolled in Medicare to ensure coverage. Beneficiaries can locate such suppliers through the Medicare.gov website or by contacting Medicare directly.
The chosen supplier receives the doctor’s order and verifies coverage with Medicare. The supplier handles necessary paperwork, submitting the claim to Medicare on behalf of the beneficiary. For certain power wheelchairs or scooters, Medicare may require prior authorization. This means the DME supplier will work with the treating provider to submit a request and supporting documents to Medicare for approval before the equipment is provided.
Upon approval, the supplier arranges for the delivery and setup of the wheelchair. They provide instruction on its proper use and any necessary adjustments. Medicare may cover wheelchairs through either a rental or purchase arrangement, depending on the equipment type and Medicare guidelines. Manual wheelchairs may be rented initially with a purchase option, while some power wheelchairs require a 13-month rental period before the beneficiary owns the equipment.
Understanding Your Costs and Ongoing Care
When obtaining a wheelchair through Medicare Part B, beneficiaries have financial responsibilities. After meeting the annual Medicare Part B deductible ($257 in 2025), beneficiaries are responsible for a 20% coinsurance of the Medicare-approved amount. Medicare covers the remaining 80% of the approved cost. For example, if a wheelchair’s Medicare-approved cost is $2,000, Medicare pays $1,600, and the beneficiary pays $400 after meeting their deductible.
Many beneficiaries utilize Medigap policies (Medicare Supplement Insurance) or other secondary insurance plans to help cover out-of-pocket costs, including the Part B deductible and coinsurance. These supplemental plans can reduce the financial burden associated with DME. Confirm that the supplier accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment and will not bill the beneficiary for more than the deductible and coinsurance.
Medicare also covers necessary repairs and maintenance to keep durable medical equipment, including wheelchairs, in good working order. This ensures the equipment remains functional. If a wheelchair becomes irreparable or a different type of mobility device is medically necessary due to a change in condition, Medicare may cover its replacement.