Does Medicare Pay for Electric Wheelchairs?

Medicare plays a significant role in providing health coverage for millions of Americans, primarily those aged 65 and older, and certain younger individuals with disabilities. This federal health insurance program helps manage healthcare expenses, which can include a range of medical equipment designed to assist with daily living. Understanding how Medicare covers specific items, such as electric wheelchairs, involves navigating its detailed guidelines for medical necessity and beneficiary responsibilities.

Medicare Coverage Criteria for Power Mobility Devices

Medicare Part B covers power-operated vehicles (scooters) and power wheelchairs as durable medical equipment (DME). For coverage, these devices must be medically necessary, meaning they are required to treat a condition and meet accepted medical standards. DME must be durable, for repeated use, primarily for a medical purpose, and not generally useful to someone without illness or injury. The device must be for use in the home, though beneficiaries can be approved to use it outside.

A health condition must cause significant difficulty moving around within the home for Medicare coverage. This includes an inability to perform essential activities of daily living, such as bathing, dressing, or using the bathroom, even with a cane, crutch, or walker. The individual must also be able to safely operate the power mobility device or have someone consistently available to assist them.

Before Medicare covers a power mobility device, a physician must conduct a face-to-face examination. This assesses the patient’s mobility limitations and needs, and the physician must document why a power wheelchair or scooter is medically necessary. The written order must include the patient’s name, item description, examination date, relevant diagnoses, and estimated length of need. This order, with supporting medical records, must be sent to the DME supplier within 45 days of the examination.

The home environment must also be suitable for the device. A doctor or DME supplier needs to verify the home has sufficient space and accessible doorways. Medicare covers both power wheelchairs and scooters, with the choice medically driven by the user’s physical capabilities and specific needs.

Steps to Obtain Medicare Coverage

Securing Medicare coverage for a power mobility device begins with a visit to the treating physician. During this face-to-face appointment, the doctor evaluates the individual’s medical condition and mobility limitations to determine the necessity of a power wheelchair or scooter.

After the physician determines medical necessity, a written prescription for the specific power mobility device is generated. This prescription and detailed medical records are forwarded by the physician’s office to a Medicare-approved durable medical equipment (DME) supplier.

Choosing a supplier that accepts Medicare assignment is important. The supplier compiles all necessary documentation, including the physician’s order and medical records, for submission to Medicare. For certain power wheelchairs, Medicare requires prior authorization, meaning the supplier must submit an approval request before providing the device. Medicare typically reviews these requests and communicates a decision within 10 business days.

Once Medicare approves the request, the DME supplier arranges delivery of the power mobility device. Upon delivery, the supplier provides instruction on how to safely and effectively use the equipment. This ensures the beneficiary is comfortable and capable of operating their new mobility aid.

Understanding Your Costs

When Medicare covers a power mobility device, beneficiaries are responsible for certain out-of-pocket costs. These devices fall under Medicare Part B, which has an annual deductible that must be met before coverage begins. For 2025, the Medicare Part B annual deductible is $257.

After the deductible is satisfied, Medicare typically pays 80% of the Medicare-approved amount for durable medical equipment. The beneficiary is then responsible for the remaining 20% coinsurance. This coinsurance amount is based on the price Medicare has determined is reasonable for the equipment, not necessarily the supplier’s initial charge.

It is important to use a supplier who accepts Medicare assignment. This means the supplier agrees to be paid directly by Medicare and accepts the Medicare-approved amount as full payment. This prevents the supplier from billing the beneficiary for more than the Medicare deductible and coinsurance. If a supplier does not accept assignment, they may charge more than the Medicare-approved amount, leaving the beneficiary responsible for the difference.

Supplemental insurance, such as Medigap policies, can help cover some or all of the 20% coinsurance that Medicare Part B does not pay. Medicare Advantage Plans, an alternative to Original Medicare, also cover durable medical equipment but may have different cost-sharing structures, including varying deductibles, copayments, and coinsurance amounts. If a power mobility device does not meet Medicare’s strict coverage criteria, the beneficiary would be responsible for the full cost.