Does Medicare Cover Wheelchairs? Eligibility and Costs

Medicare plays a significant role in assisting beneficiaries with the costs associated with necessary medical equipment, including wheelchairs. This support falls under specific guidelines designed to ensure that equipment is medically appropriate and used within a home setting. The program aims to provide coverage for durable medical equipment that supports daily living for those with qualifying conditions.

Medicare Eligibility for Wheelchairs

To receive coverage for a wheelchair through Medicare, an individual must be enrolled in Medicare Part B, which covers durable medical equipment (DME). A fundamental requirement for coverage is a doctor’s determination that the wheelchair is medically necessary. This involves a written order or prescription from the treating physician. The equipment must be for use primarily in the individual’s home.

Types of Wheelchairs and Coverage Criteria

Durable Medical Equipment (DME) encompasses items that can withstand repeated use, serve a medical purpose, are used primarily in the home, and have an expected lifespan of at least three years. Wheelchairs, including manual wheelchairs, power-operated vehicles (scooters), and power wheelchairs, are examples of DME covered by Medicare Part B. The specific type of wheelchair covered depends on an individual’s medical necessity and their ability to operate the device.

For a manual wheelchair, coverage is available if an individual cannot safely use a cane or walker but possesses sufficient upper body strength or has assistance to operate it. If an individual cannot use a cane, walker, or manual wheelchair, they might qualify for a power-operated scooter, provided they can safely get in and out of it and have the strength to operate its controls. Power wheelchairs are considered if an individual cannot operate a manual wheelchair or does not qualify for a power-operated scooter.

The core of Medicare’s coverage criteria centers on medical necessity, which requires that the individual’s health condition causes significant difficulty moving around within their home. This includes an inability to perform activities of daily living (ADLs) such as bathing, dressing, or using the bathroom, even with the aid of a cane, crutch, or walker. The individual or an available caregiver must also be able to safely operate and get on and off the equipment.

A physician must document these specific medical needs, ensuring the condition necessitates the wheelchair and is not expected to improve to the point where the device is no longer needed. The doctor or supplier must also verify that the equipment can be used effectively within the home environment, considering factors like doorway sizes and maneuvering space.

Steps to Obtain Coverage

The process of obtaining a wheelchair covered by Medicare begins with a detailed assessment by a physician. Individuals must have a face-to-face examination with their treating doctor to assess their mobility needs and determine if a wheelchair is medically necessary for use in their home. Following this examination, the physician will provide a written order, sometimes referred to as a Certificate of Necessity, which specifies the type of wheelchair required and explains the medical reasons for its need. This written order is a foundational piece of documentation for Medicare coverage.

After securing the physician’s order, the next step involves working with a Medicare-approved durable medical equipment (DME) supplier. It is important to confirm that the chosen supplier is enrolled in Medicare and accepts assignment. The DME supplier is responsible for submitting the claim to Medicare, including all necessary documentation from the physician. For certain types of power wheelchairs and scooters, prior authorization from Medicare may be required before the equipment can be delivered. This involves the supplier submitting a request with supporting medical records for Medicare review to confirm eligibility and medical necessity.

Understanding Your Costs

Medicare Part B covers durable medical equipment, including wheelchairs, once the annual Part B deductible has been met. For 2025, the annual deductible for Medicare Part B beneficiaries is $257. After this deductible is satisfied, Medicare Part B covers 80% of the Medicare-approved amount for the equipment. The beneficiary is responsible for the remaining 20% coinsurance.

It is important to select a Medicare-approved supplier that accepts “assignment,” meaning they agree to accept the Medicare-approved amount as full payment. If a supplier does not accept assignment, they may charge more than the Medicare-approved amount, and the beneficiary could be responsible for the difference. In some cases, Medicare may require the equipment to be rented for a period, 13 months, after which ownership transfers to the beneficiary. Individuals with secondary insurance, such as Medigap policies, Medicaid, or employer-sponsored health plans, may find that these plans help cover the remaining 20% coinsurance and the deductible, further reducing out-of-pocket costs.