Does Medicare Pay for a Wheelchair?

Medicare, the federal health insurance program, assists individuals with mobility needs. For those requiring a wheelchair, Medicare may offer coverage under specific circumstances. This support primarily falls under the Durable Medical Equipment (DME) benefit, which includes various items designed for repeated use in the home to address a medical condition or injury. Coverage requires meeting specific conditions. Medicare aims to ensure beneficiaries receive medically necessary equipment to improve their ability to perform daily activities.

Medicare Coverage Requirements

Medicare Part B covers durable medical equipment, including wheelchairs, when deemed medically necessary. A healthcare provider must determine that the equipment is essential for treating an illness or injury, or to improve the functioning of a malformed body part. A key requirement for coverage is a face-to-face examination with the treating physician. During this evaluation, the doctor assesses the individual’s mobility limitations and verifies the need for a wheelchair.

The physician must then issue a detailed written order, sometimes called a Certificate of Medical Necessity, specifying the need for the device for use within the home. This documentation must clearly explain why other mobility aids, such as a cane, crutches, or a walker, are insufficient to meet the individual’s mobility needs in their home. The equipment must be primarily for use in the beneficiary’s home. The home environment must also be suitable for the equipment, ensuring adequate space for maneuvering.

Types of Wheelchairs and Mobility Devices Covered

Medicare may cover different types of mobility devices, including manual wheelchairs, power wheelchairs, and scooters, often referred to as Power-Operated Vehicles (POVs).

Manual wheelchairs are covered if the individual cannot use a cane or walker safely but possesses sufficient upper body strength to self-propel the wheelchair, or has someone consistently available to assist them. Power wheelchairs are considered when an individual cannot self-propel a manual wheelchair but can safely operate a power device. Scooters (POVs) are covered for those who can stand and transfer safely but need assistance with mobility for longer distances within the home, or who cannot operate a manual wheelchair.

Understanding Medicare Part B Costs

Medicare Part B helps cover the cost of durable medical equipment, including wheelchairs, after the annual Part B deductible is met. For 2025, the standard annual deductible for Medicare Part B is $257. Once this deductible is met, Medicare Part B pays 80% of the Medicare-approved amount for the equipment.

The beneficiary is then responsible for the remaining 20% coinsurance. The “Medicare-approved amount” is the payment Medicare has agreed to cover for an item, which may be less than the actual charge by the supplier. To avoid higher out-of-pocket costs, choose a supplier who “accepts assignment.” This means the supplier agrees to accept the Medicare-approved amount as full payment and will only bill the beneficiary for the deductible and coinsurance. Medigap policies, or Medicare Supplement Insurance, can help cover the 20% coinsurance and other out-of-pocket expenses not covered by Original Medicare.

Steps to Obtain a Wheelchair

Obtaining a wheelchair through Medicare involves a structured process. The first step requires a visit to the treating physician for a face-to-face evaluation to determine the medical necessity for a wheelchair. The doctor will then write a detailed prescription or order for the specific type of mobility device needed.

After receiving the prescription, choose a durable medical equipment (DME) supplier enrolled in Medicare and who accepts assignment. The supplier will then gather all necessary documentation, including the physician’s order and medical records, to submit a claim to Medicare for approval. For certain power wheelchairs, prior authorization may be required before Medicare will cover the cost, and the supplier can assist with this submission. Medicare has specific rules regarding whether a wheelchair is rented or purchased. Power wheelchairs, for instance, are often rented for 13 months, after which ownership transfers to the beneficiary.