Does Medicare Cover Wheelchairs? Eligibility & Costs

Medicare, the federal health insurance program, plays a significant role in helping beneficiaries manage their health needs, including access to essential medical equipment. This program provides coverage for Durable Medical Equipment (DME), which encompasses various devices designed for long-term use in a home setting. Wheelchairs are a common example of DME that Medicare may cover, offering mobility support for individuals facing health-related challenges.

Covered Wheelchair Types

Durable Medical Equipment (DME) refers to medical devices and supplies that are intended for repeated use, serve a medical purpose, and are typically used in the home. These items are generally expected to last for at least three years. Wheelchairs fall under this classification, providing crucial mobility assistance for individuals with specific health conditions.

Medicare Part B generally covers several types of wheelchairs and mobility aids, each designed to meet varying levels of need. Manual wheelchairs, propelled by the user or an assisting caregiver, are covered if the beneficiary cannot use a cane or walker safely but possesses adequate upper body strength or has assistance available. Power wheelchairs are motorized devices suitable for individuals who cannot operate a manual wheelchair due to upper body limitations or other physical constraints, and who require mobility within their home. Power-operated vehicles, often called scooters, are also covered for those who cannot use a cane, walker, or manual wheelchair, provided they can safely operate and get on and off the device. Medicare also typically covers necessary accessories for these mobility devices, ensuring they function effectively for the beneficiary’s needs.

Eligibility for Coverage

For Medicare to cover a wheelchair, several specific conditions must be met. A treating physician must determine that the wheelchair is medically necessary for the beneficiary’s use within their home. This means the individual has a health condition causing significant difficulty moving around their residence, and they are unable to perform daily activities like bathing, dressing, or using the bathroom, even with simpler aids such as a cane or walker.

A written order or prescription from the treating physician is also required. This document typically includes the diagnosis, the specific type of equipment needed, and the duration of the need. The physician must conduct a face-to-face examination to assess the beneficiary’s mobility limitations and confirm their ability to safely operate the requested equipment, or confirm that assistance is available. Furthermore, coverage falls under Medicare Part B, so beneficiaries must be enrolled in this part of Medicare. The wheelchair must be obtained from a supplier enrolled in Medicare.

Steps to Obtain a Wheelchair

The process of obtaining a wheelchair through Medicare involves several practical steps. The journey begins with a consultation with the treating physician, who will assess the mobility needs and, if appropriate, issue a written prescription. This assessment ensures that the requested wheelchair aligns with the individual’s specific medical requirements for use within the home environment.

Following the physician’s prescription, the beneficiary works with a Medicare-enrolled Durable Medical Equipment (DME) supplier. It is important to choose a supplier that accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment for covered services. For certain types of power wheelchairs, prior authorization may be required before the equipment can be provided. The DME supplier will typically handle the submission of the prior authorization request to Medicare.

Beneficiary Costs

When Medicare covers a wheelchair, beneficiaries are responsible for certain financial contributions. For Original Medicare Part B, after the annual deductible is met, Medicare typically pays 80% of the Medicare-approved amount for the wheelchair. The beneficiary is then responsible for the remaining 20% as coinsurance. The Medicare Part B annual deductible for 2025 is $257.

Medicare may require renting the equipment for a period, often 13 months, after which ownership transfers to the beneficiary. While Medicare Advantage plans are required to provide at least the same coverage as Original Medicare, their cost-sharing rules, including deductibles, copayments, and coinsurance, can differ, and beneficiaries should consult their specific plan details.