Does Medicare Pay for Electric Wheelchairs?

Medicare Part B may cover electric wheelchairs, categorized as Durable Medical Equipment (DME), under specific conditions. Understanding this coverage is important for individuals facing mobility challenges.

Understanding Medicare Coverage Requirements

Medicare’s coverage for an electric wheelchair requires it to be classified as Durable Medical Equipment (DME). This means the equipment must be durable, able to withstand repeated use, serve a medical purpose, and generally not be useful to a person without illness or injury. It must also be appropriate for use in the home.

A primary requirement is medical necessity, meaning a physician must determine the electric wheelchair is essential for managing an illness, injury, or its symptoms. The patient’s medical condition must significantly limit their ability to move around their home, and this limitation cannot be sufficiently addressed by less supportive mobility aids such as a cane, walker, or manual wheelchair. The electric wheelchair must enable the individual to perform mobility-related activities of daily living (MRADLs) within their home, such as bathing, dressing, or moving between a bed or chair and the bathroom.

The “in-home use” requirement specifies that the patient must primarily use the wheelchair within their residence. Medicare does not cover equipment primarily intended for outdoor mobility or convenience rather than medical necessity for in-home use.

A Medicare-enrolled physician must determine this medical necessity and provide a written order. This process begins with a face-to-face examination where the doctor assesses the patient’s mobility limitations and confirms the need for an electric wheelchair. The physician must document why a power wheelchair is necessary over other mobility aids, including a detailed history and physical examination focused on mobility.

The physician must then write a detailed written order, sometimes called a Certificate of Necessity or prescription. This order must include the patient’s name, examination date, relevant diagnoses, a description of the ordered item, the length of need, and the physician’s signature and date. This order and supporting medical records must be sent to the durable medical equipment supplier within 45 days of the examination.

Steps to Obtain a Covered Electric Wheelchair

To obtain a Medicare-covered electric wheelchair, begin with a consultation with your physician. During this face-to-face visit, the doctor will evaluate your mobility challenges and determine if an electric wheelchair is medically necessary for daily activities within your home, documenting why other mobility aids are insufficient.

After determining medical necessity, the physician prepares a detailed written order (prescription or Certificate of Necessity). This document outlines your medical condition and explains why an electric wheelchair is required for daily living tasks. The physician then transmits this prescription and supporting medical records to an authorized DME supplier, typically within 45 days of your evaluation.

Selecting a Medicare-approved supplier is important. These suppliers accept Medicare assignment, agreeing to the payment amount Medicare approves. The supplier works with your doctor to ensure all necessary documentation is complete and submitted to Medicare for approval, including requesting prior authorization for certain power wheelchairs.

The supplier or a qualified professional may assess your home environment to confirm the wheelchair will fit and maneuver safely. Once Medicare approves the request, the supplier delivers the electric wheelchair and provides instruction on its safe operation and maintenance.

Financial Responsibilities and Supplier Choices

When Medicare covers an electric wheelchair, beneficiaries are responsible for certain out-of-pocket costs. Medicare Part B, which covers durable medical equipment, typically pays 80% of the Medicare-approved amount for the electric wheelchair after the annual deductible has been met. The beneficiary is then responsible for the remaining 20% coinsurance. For 2025, the annual deductible for Medicare Part B is $257.

Choosing a supplier who accepts Medicare assignment is beneficial for limiting out-of-pocket expenses. When a supplier accepts assignment, they agree to accept Medicare’s approved amount as full payment. This means they can only charge you the 20% coinsurance after the deductible is met. If a supplier does not accept assignment, they may charge more than the Medicare-approved amount, and you could be responsible for the difference in addition to the coinsurance.

It is important to verify that the durable medical equipment supplier is enrolled in Medicare and accepts assignment before obtaining any equipment. Beneficiaries can find Medicare-approved suppliers through the Medicare website or by contacting Medicare directly. Ensuring the supplier’s participation helps guarantee Medicare will process the claim and contribute to the cost.

Power-Operated Vehicles and Other Considerations

Medicare Part B covers both power wheelchairs and power-operated vehicles (scooters) as durable medical equipment, but with specific distinctions. Power wheelchairs are generally controlled with a joystick, often prescribed for individuals with limited upper body strength or coordination. Scooters are typically steered with a tiller, requiring sufficient trunk stability and hand strength. Both require medical necessity and in-home use, with specific criteria reflecting their design and functional differences.

Medicare may also cover repairs and maintenance for an approved electric wheelchair if it remains medically necessary. The supplier must maintain physician documentation confirming continued medical need and that repairs are reasonable and necessary. Replacement is typically covered only once every five years, unless there is irreparable damage or a significant change in medical condition.

If Medicare denies coverage, beneficiaries have the right to appeal the decision. The appeals process involves several levels, starting with a redetermination request. Further levels of appeal, including reconsideration by an independent review entity and a hearing with an Administrative Law Judge, are available to present additional information or arguments.