How to Get a Wheelchair Through Medicare

Obtaining a wheelchair can seem complex, but understanding Medicare’s role simplifies the process. Medicare offers support for individuals needing mobility assistance, provided certain criteria are met. This guide clarifies how Medicare beneficiaries can secure a wheelchair.

Understanding Medicare Coverage for Wheelchairs

Medicare provides coverage for various mobility assistance equipment, including wheelchairs, under its Durable Medical Equipment (DME) benefit. DME refers to items that are used in the home, can withstand repeated use, have a medical purpose, and are not typically useful to someone who is not sick or injured. Wheelchairs meet these criteria, making them eligible for coverage.

Specific types of wheelchairs covered include manual wheelchairs, which require the user or a caregiver to propel them, and power wheelchairs or scooters. Medicare covers these devices if they are medically necessary for use within the home. This means the equipment must be required to help an individual perform daily living activities, such as bathing, dressing, or using the bathroom, that they cannot accomplish even with less supportive devices like canes or walkers. Coverage is generally for in-home use, not solely for activities outside the home, though incidental outside use may occur. Medicare Part B, Medical Insurance, covers these durable medical equipment items.

Meeting Medicare’s Eligibility Requirements

To qualify for wheelchair coverage, beneficiaries must be enrolled in Medicare Part B. This part of Medicare addresses outpatient care and durable medical equipment. The process begins with a comprehensive evaluation by a Medicare-enrolled physician.

The prescribing physician must conduct a face-to-face examination of the patient. This examination assesses the patient’s mobility needs and determines if a wheelchair is medically necessary for use in their home. The physician must then provide a written order detailing the patient’s diagnosis, the medical justification for the wheelchair type, and how it will improve mobility for daily activities within the home.

The physician’s medical records must document the medical necessity, outlining why less supportive mobility aids are insufficient. The physician’s order should be completed no more than 45 days after the face-to-face examination.

The Process of Obtaining Your Wheelchair

Once the necessary medical documentation and physician’s order are secured, the next step involves finding a Medicare-approved supplier. It is important to choose a supplier enrolled in Medicare and possessing a Medicare supplier number to ensure coverage. Using a supplier that does not accept Medicare or its assigned amounts could result in the beneficiary paying the full cost.

A supplier who “accepts assignment” agrees to accept Medicare’s approved amount as full payment for the equipment. This arrangement means the supplier can only bill the beneficiary for their portion of the cost, such as the deductible and coinsurance. The physician’s order and other prepared documentation are then submitted to this chosen supplier.

The supplier’s role extends to verifying coverage, processing claims with Medicare, and coordinating with the prescribing physician if additional information is required. They will also typically conduct an assessment to ensure the proper fitting of the wheelchair and that it can be safely used within the beneficiary’s home, including fitting through doorways. After approval, the supplier arranges for delivery and provides basic training on the wheelchair’s operation and maintenance.

Financial Considerations and Post-Delivery

Understanding the financial obligations is important when obtaining a wheelchair through Medicare. After meeting the annual Medicare Part B deductible, which is $257 in 2025, beneficiaries are responsible for a 20% coinsurance of the Medicare-approved amount for the durable medical equipment. Medicare covers the remaining 80%.

Medicare’s policy on renting versus buying wheelchairs varies by equipment type. For many items, including some power wheelchairs, Medicare initially requires a rental period, often 13 months, before ownership transfers to the beneficiary. However, some items may be purchased outright from the start, or beneficiaries may have a choice between renting and buying, particularly for items costing less than $150.

After delivery, Medicare continues to provide coverage for necessary maintenance and repairs to keep the wheelchair functional. This includes parts and labor, provided the repairs are reasonable and necessary to make the equipment serviceable. Medicare may also cover replacement wheelchairs under specific conditions, such as if the original equipment is lost, stolen, damaged beyond repair, or no longer medically appropriate after a minimum of five years of use.