How Does Medicare Pay for Wheelchairs?

Wheelchairs serve as mobility aids for many individuals facing physical limitations, enabling greater independence and participation in daily life. In the context of healthcare coverage, a wheelchair is categorized as Durable Medical Equipment (DME), which is reusable medical equipment prescribed by a doctor for use in the home. Understanding how Medicare, the federal health insurance program, covers these devices can help beneficiaries navigate the process of obtaining necessary mobility assistance.

Medicare’s Coverage for Wheelchairs

Medicare provides coverage for wheelchairs primarily under Medicare Part B, which addresses medical insurance. For Medicare Part B to cover a wheelchair, it must be medically necessary for an individual’s condition and prescribed by a healthcare provider. Medical necessity means the equipment is required due to an illness or injury that limits mobility. The wheelchair must be primarily used in the individual’s home to help manage a health condition or aid in recovery. While a hospital or a short-term nursing home stay does not qualify as a “home” for DME coverage, a long-term care facility can meet this definition.

Types of Wheelchairs Covered

Medicare covers various types of wheelchairs, each with specific criteria for medical necessity. Manual wheelchairs are typically covered if an individual cannot use a cane or walker safely but possesses sufficient upper body strength to operate the chair, or has consistent assistance from a caregiver. These are often suitable for basic mobility needs.

Power-operated vehicles (POVs), commonly known as scooters, may be covered for individuals who cannot use a cane or walker, or operate a manual wheelchair. To qualify for a scooter, a person must be able to safely get in and out of the device and possess the strength to sit upright and control it. Power wheelchairs, which are generally more robust, are considered if a person cannot operate a manual wheelchair or scooter, or is unable to perform daily living activities without the assistance of a power wheelchair.

Eligibility and Requirements

To qualify for Medicare coverage of a wheelchair, several specific conditions and documentation requirements must be met. A doctor must conduct a face-to-face examination to assess mobility limitations and certify the medical necessity of the wheelchair. This examination determines how a health condition impairs movement within the home and why alternative mobility aids are insufficient.

The prescription provided by the doctor must specify the type of wheelchair needed. The wheelchair must be obtained from a Medicare-enrolled supplier who accepts Medicare assignment, meaning they agree to accept Medicare’s approved amount as full payment. For certain power wheelchairs and scooters, prior authorization from Medicare may be required before the equipment is delivered.

The Process for Obtaining a Wheelchair

The process of obtaining a Medicare-covered wheelchair begins with a visit to the individual’s doctor to discuss mobility challenges. During this appointment, the doctor will assess the medical need for a wheelchair and provide a written order or prescription. This documentation details the specific type of wheelchair required and explains how it addresses the patient’s mobility limitations.

After receiving the doctor’s order, the next step involves selecting a Medicare-enrolled Durable Medical Equipment (DME) supplier. The chosen supplier is then responsible for submitting the doctor’s order and all other necessary documentation to Medicare. If prior authorization is required for the specific type of power wheelchair or scooter, the supplier will facilitate this request with Medicare. Following approval, the supplier arranges for the delivery of the wheelchair and provides any necessary training on its use.

Costs and Financial Considerations

When Medicare covers a wheelchair, beneficiaries are responsible for certain costs. The annual Medicare Part B deductible must be met before Medicare begins to pay its share. For 2025, this deductible is $257.

Once the deductible is satisfied, Medicare pays 80% of the Medicare-approved amount for the wheelchair. The beneficiary is then responsible for the remaining 20% coinsurance. Medicare may cover wheelchairs through either rental or purchase. For some equipment, ownership may transfer to the beneficiary after 13 months of continuous rental payments.