What Kind of Wheelchair Will Medicare Pay For?

Medicare, a federal health insurance program, provides coverage for various healthcare services and equipment. Medicare Part B covers durable medical equipment (DME), including wheelchairs, when medically necessary. This coverage supports beneficiaries in maintaining independence and addressing mobility challenges within their home environments. Understanding Medicare’s policies for wheelchair coverage is important for individuals seeking this assistance.

Meeting Medicare’s Requirements

Medicare Part B covers durable medical equipment (DME), such as wheelchairs, when a medical professional prescribes it for use in the beneficiary’s home. To qualify, individuals must be enrolled in Medicare Part B. The equipment must be medically necessary to address a health condition that significantly impairs mobility within the home.

A comprehensive evaluation by a treating physician is a prerequisite for Medicare wheelchair coverage. This includes a face-to-face examination with the physician, which must occur within six months prior to the written order. During this examination, the physician assesses mobility limitations and documents the medical need for the wheelchair for use in the patient’s home, also explaining why alternative mobility aids, such as a cane or walker, are insufficient. The home environment must also be suitable for safe wheelchair use, allowing the equipment to maneuver through doorways and living spaces.

Understanding Covered Wheelchair Types

Medicare Part B covers various types of mobility devices as durable medical equipment, each with specific medical criteria. Manual wheelchairs are an option for individuals who cannot use a cane or walker safely but possess sufficient upper body strength to propel themselves, or have a caregiver available to assist. These can range from standard models to lightweight or ultralightweight versions, depending on the user’s needs and ability to self-propel within the home.

For those with greater mobility limitations, power-operated vehicles (POVs), also known as scooters, may be covered. A scooter is considered when an individual can stand and walk but requires assistance for mobility outside the home or for longer distances, and cannot operate a manual wheelchair. The individual must also be able to safely get on and off the scooter and operate its controls.

Power wheelchairs are covered if the individual cannot operate a manual wheelchair, even with assistance, and a scooter does not adequately address their mobility needs. This typically applies to individuals with severe weakness, limited endurance, or medical conditions like neurological disorders or myopathy. For certain advanced power wheelchairs, a specialty evaluation by a licensed medical professional, such as a Physical Therapist or Occupational Therapist, may be required to document the medical necessity for the wheelchair and its specialized features.

Navigating the Coverage Process

Once medical necessity and the appropriate wheelchair type are identified, the next step is finding a Medicare-approved supplier. Use a supplier enrolled in Medicare that accepts assignment, meaning they agree to accept the Medicare-approved amount as full payment. This limits your out-of-pocket costs to the deductible and coinsurance.

The supplier submits necessary documentation to Medicare, working with the treating physician to gather prescriptions, medical records, and other required paperwork. This initiates Medicare’s review process to verify eligibility and medical necessity.

Certain wheelchairs, particularly some power wheelchairs and scooters, may require prior authorization from Medicare. Medicare reviews these requests in advance to determine if the equipment meets coverage guidelines. The Durable Medical Equipment Medicare Administrative Contractor (DME MAC) typically responds to prior authorization requests within ten business days for initial submissions, or sooner if an expedited review is medically necessary. If approved, the supplier arranges for delivery, fitting, and training on proper use.

Financial Responsibility and Maintenance

Securing a wheelchair through Medicare involves specific financial responsibilities for the beneficiary. After meeting the annual Medicare Part B deductible ($257 in 2025), individuals are generally responsible for a 20% coinsurance of the Medicare-approved amount. Medicare Part B covers the remaining 80% of the approved cost.

Medicare’s policy on wheelchairs often involves a “rent vs. buy” decision. Many power wheelchairs and power-operated vehicles are initially rented for a continuous period of 13 months. After this 13-month rental period, ownership of the equipment typically transfers to the beneficiary. Manual wheelchairs, however, are usually purchased outright.

Medicare generally covers repairs for wheelchairs and scooters if the equipment remains medically necessary, covering 80% of the Medicare-approved amount with the beneficiary paying the 20% coinsurance. However, routine maintenance, such as changing tires, is typically not covered unless specifically outlined, and damage due to misuse is generally excluded. For rented equipment, the supplier is responsible for repair costs. Replacement of a wheelchair is typically covered after its “reasonable useful lifetime,” generally considered five years from the date of delivery, or sooner if the equipment is lost, stolen, or irreparably damaged, provided medical necessity continues.