Does Medicare Cover Wheelchairs? Here’s How It Works

Medicare Part B, which covers medical insurance, provides coverage for Durable Medical Equipment (DME), including wheelchairs. It assists individuals with a medical necessity for equipment to improve mobility and daily activities. Specific criteria must be met for coverage.

Meeting Medicare’s Coverage Requirements

Medicare’s coverage for a wheelchair requires medical necessity, assessed by a healthcare provider. A Medicare-enrolled doctor must provide a written order for home use, based on a face-to-face examination evaluating mobility limitations.

The individual must have a health condition severely restricting movement within their home, preventing essential activities of daily living (ADLs) like bathing, dressing, or using the bathroom, even with less supportive devices like a cane or walker. The home must have adequate space and clear pathways for safe and effective use.

The individual must safely operate the wheelchair or scooter, or have a consistent caregiver available. The doctor and DME supplier must accept Medicare assignment, agreeing to the Medicare-approved payment amount. These comprehensive requirements ensure that Medicare covers equipment only when it is truly necessary for the individual’s health and mobility within their personal living space.

Identifying Covered Wheelchair Types

Medicare covers manual wheelchairs, power-operated vehicles (scooters), and power wheelchairs, each with specific medical justifications. Manual wheelchairs are for individuals who cannot safely use a cane or walker but have sufficient upper body strength to self-propel for daily home activities.

Scooters are for individuals unable to use a cane, walker, or manual wheelchair, but who can safely operate controls and get on and off the device. This option suits those with limited upper body strength or conditions preventing manual propulsion, yet still able to maintain control of a motorized device. Power wheelchairs are covered if an individual cannot effectively use a manual wheelchair in their home or does not qualify for a scooter, due to lack of upper body strength or coordination.

Recent policy updates have expanded coverage to include power seat elevation features for power wheelchairs. This enhancement is covered when medically necessary for transfers or to improve mobility-related activities of daily living (MRADLs) such as dressing, grooming, toileting, feeding, and bathing. This supports greater independence in their home environment.

Steps to Obtain a Wheelchair

Obtaining a wheelchair through Medicare begins with your healthcare provider. First, obtain a detailed prescription from your doctor, who must be enrolled in Medicare. This prescription will specify the type of wheelchair needed and confirm its medical necessity based on your condition and mobility limitations.

Once you have a prescription, you must find a Durable Medical Equipment (DME) supplier that is approved by Medicare. It is important to confirm that the supplier participates in Medicare and accepts assignment. The DME supplier plays a significant role in the subsequent steps, often handling much of the necessary paperwork and coordination with Medicare on your behalf.

For certain types of wheelchairs, particularly power wheelchairs, prior authorization may be required. Your DME supplier will work with your treating provider to submit the prior authorization request and all supporting documentation to Medicare for review. Medicare will then review the information to ensure all eligibility and coverage requirements are met. If approved, the supplier will deliver the wheelchair for your use in your home.

Beneficiary Costs and Specific Rules

Beneficiaries are responsible for out-of-pocket costs. After meeting the annual Medicare Part B deductible ($240 in 2024), individuals typically pay 20% of the Medicare-approved amount for the equipment. Medicare pays the remaining 80% if the supplier accepts assignment.

Manual wheelchairs are often rented for the first 13 months before ownership transfers to the beneficiary. This rental period allows flexibility if medical needs change. Power wheelchairs and scooters may be rented or purchased, depending on Medicare rules.

Medicare covers necessary repairs and maintenance for the wheelchair, up to the cost of replacing the equipment. Supplemental insurance, such as a Medigap policy or Medicare Advantage Plan, may alter your out-of-pocket costs. These plans can help cover the 20% coinsurance or have their own rules regarding DME coverage and approved suppliers.