How Much Does Medicare Pay for a Power Wheelchair?
Understand how Medicare covers power wheelchairs. Learn about eligibility, the approval process, and your potential out-of-pocket costs for mobility.
Power wheelchairs enhance mobility and independence for individuals with physical limitations. These devices represent a financial investment. Understanding how Medicare covers power wheelchairs is important for beneficiaries. Navigating requirements and processes helps ensure access to this equipment.
Understanding Medicare Coverage for Power Wheelchairs
Medicare covers power wheelchairs as Durable Medical Equipment (DME). DME is equipment for medical purposes, used in the home, lasting at least three years, and not useful to someone not sick or injured.
Power wheelchairs fall under Medicare Part B, which covers outpatient care and medical supplies. Coverage requires the equipment to be medically necessary. A physician must prescribe the power wheelchair for use in the beneficiary’s home due to a medical condition.
Under Original Medicare Part B, Medicare pays 80% of the Medicare-approved amount for the power wheelchair. The beneficiary is responsible for the remaining 20% coinsurance after meeting their annual Part B deductible. The Part B deductible is $257 in 2025.
Medicare aims to ensure beneficiaries have the least expensive mobility option that meets their needs. If a cane, walker, or manual wheelchair sufficiently addresses mobility limitations, a power wheelchair might not be covered.
Meeting Eligibility and Documentation Requirements
To qualify for Medicare coverage, a beneficiary must have a medical condition severely impairing home mobility. This impairment must prevent daily activities, such as bathing or dressing, even with a cane, crutch, or walker. The power wheelchair must be for use within the beneficiary’s home, though it can also be used outside once approved.
A beneficiary must safely operate the power wheelchair, or have a caregiver consistently available to operate it. The physician or supplier must verify the home environment, including doorways and pathways, can accommodate the equipment. This ensures the device is practical and safe.
A face-to-face examination with a doctor or other qualified medical professional is a step in the documentation process. This examination must assess mobility needs before the prescription is written. Medical notes from this visit must document mobility limitations, explain why other aids are insufficient, and confirm the patient’s ability to operate the device.
Following the examination, the doctor must issue a written order or prescription for the power wheelchair. This order should include the type of power wheelchair, examination date, and doctor’s signature. The prescription and supporting medical records must be submitted to a Medicare-enrolled Durable Medical Equipment (DME) supplier within 45 days of the face-to-face encounter.
Navigating the Approval and Payment Process
After meeting eligibility and gathering documentation, the process involves a Medicare-enrolled DME supplier. The supplier takes the medical records and doctor’s prescription. They submit this documentation to Medicare for review and approval.
For some power wheelchairs, Medicare requires prior authorization before equipment is provided. The supplier submits documentation, and Medicare reviews it to confirm medical necessity and eligibility before approving payment. Wait for Medicare’s approval before taking possession to ensure coverage.
Upon approval, the supplier arranges delivery of the power wheelchair. During delivery, ensure the device matches the prescription and that proper fitting and instructions are provided. The supplier then bills Medicare for the approved amount.
Medicare pays 80% of the approved amount directly to the supplier. The beneficiary is responsible for the remaining 20% coinsurance and any unmet Part B deductible. Medicare may cover rental for a period, such as 13 months, after which ownership transfers, or it may cover an outright purchase.
Your Out-of-Pocket Costs and Other Options
Beneficiaries are responsible for out-of-pocket costs, primarily the 20% coinsurance and the annual Part B deductible. These costs can accumulate, especially if other medical services are utilized throughout the year.
Ensure the Durable Medical Equipment (DME) supplier accepts Medicare assignment. When a supplier accepts assignment, they agree to accept the Medicare-approved amount as full payment. If a supplier does not accept assignment, they can charge more, and the beneficiary may be responsible for the difference in addition to coinsurance and deductible.
For beneficiaries in a Medicare Advantage (Part C) plan, coverage rules and costs for power wheelchairs might differ from Original Medicare. Medicare Advantage plans cover at least what Original Medicare covers, but may have different cost-sharing, prior authorization, or network requirements. Beneficiaries should consult their plan documents for details.
Medicare Supplement Insurance (Medigap) policies help manage out-of-pocket costs. These policies cover some or all costs Original Medicare does not, such as the 20% coinsurance and the Part B deductible. Acquiring a Medigap policy can reduce a beneficiary’s financial responsibility for a power wheelchair.