Medicare Part B (Medical insurance) covers durable medical equipment (DME), which includes wheelchairs. However, there are rules that apply to getting coverage for power-operated vehicles (scooters) and manual wheelchairs.

Let’s explore how Medicare can help cover wheelchairs.

Overview of Medicare coverage for wheelchairs

Medicare Part B will help cover a wheelchair if you meet all of the following requirements:1

  1. The doctor treating your condition must submit a written order to Medicare, called a Certificate of Necessity, stating you have a medical need for a wheelchair or scooter for use in your home
  2. You have limited mobility and meet all of these conditions:
    1. You have a health condition that causes significant difficulty moving around in your home.
    2. You’re unable to do daily living activities (like bathing, dressing, getting in or out of a bed or chair, or using the bathroom) even with the help of a cane, crutch or walker.
    3. You’re able to safely operate and get on and off the wheelchair or scooter, or have someone who is always available to help you safely use the device.
    4. The doctor treating you for the condition that requires a wheelchair or scooter, and the supplier, both accept Medicare.
    5. Your doctor or supplier has visited your home and verified that you can use the equipment within your home (example: it’s not too big to fit through doorways in your home or blocked by floor surfaces or things in its path).

If you meet these requirements, there are 3 main types of wheelchairs Medicare helps cover.2

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Manual wheelchairs

A manual wheelchair is propelled by the user by pushing on round bars that surround the wheels. You may qualify for a manual wheelchair if you can’t use a cane or walker safely but have enough upper body strength (or someone to help you).

Power scooters

A power scooter is an electric vehicle that is built more like a motor scooter than a wheelchair. You may qualify for a power-operated scooter if you don’t have the strength to use a cane or walker or can’t operate a manual wheelchair. You must be able to get in and out of a power scooter safely and strong enough to sit up and operate the controls.

Power wheelchairs

A power wheelchair consists of a seat, arm rests with controls and an electric motor. You may qualify for a power wheelchair if you can’t use a manual wheelchair or don’t qualify for a power-operated scooter. Before you get a power wheelchair, you must have a face-to-face exam with your doctor. If your doctor determines you can safely operate a power wheelchair, they’ll submit a written order to Medicare.

How do I get a wheelchair from Medicare?

Here are some common steps to get a wheelchair from Medicare:

  1. Schedule a doctor’s appointment. Your doctor will need to determine that you meet the requirements to get support from Medicare.
  2. Tell your doctor why you need a wheelchair. Explain the mobility problems you’re having and why you need help.
  3. Make sure you can operate a wheelchair safely. Practice getting in and out of a wheelchair and using it safely.
  4. Choose the best type of wheelchair for your needs. The Certificate of Necessity your doctor sends to Medicare must include the type of wheelchair you need: a manual wheelchair, power scooter or power wheelchair.
  5. Get your Certificate of Necessity signed. Once you’ve chosen the best wheelchair for your needs, your doctor can sign your certificate.
  6. Check if you’ve met your Part B deductible. Medicare will not pay for your wheelchair until you’ve met your Part B deductible ($226 in 2023).
  7. Determine whether you should rent or buy. If you don’t plan to need the wheelchair for a long time, renting may be a better option.
  8. Find a wheelchair supplier approved by Medicare. Medicare will only help pay for a wheelchair bought from a Medicare-approved supplier.
  9. Contact the supplier. Once your Certificate of Necessity is ready, you have 45 days to contact a supplier to set up a home consultation.

How much does Medicare pay for a wheelchair?

After you pay your Part B deductible for the year, Medicare pays 80% of the approved amount. You pay the other 20%.3

Appealing denied claims for wheelchairs under Medicare

Medicare may deny your request if they believe you don’t medically require a wheelchair or you didn’t submit the correct information. If Medicare denies your request, you have the right to appeal that decision.

Here are the steps to file an appeal to Medicare:4

  1. Start by looking at your Medicare Summary Notice (MSN). You must file your appeal by the date in the MSN.
  2. Submit your appeal in 1 of 2 ways:
    1. Fill out a Redetermination Request Form, PDF and send it to the company that handles your Medicare claims.
    2. Send a written request to the company that handles your Medicare claims.
  3. Be sure to include this information in your appeal:
    1. Your name, address, and the Medicare Number on your red, white and blue Medicare card
    2. The decision you’re appealing
    3. Why you’re appealing the decision
    4. Any other information that will help your case

Frequently Asked Questions

For more information on Medicare and wheelchairs, check out these FAQs.

Yes. After you meet the Part B deductible, Medicare could potentially cover 80% of the cost of the following mobility aids:5

You may need to get pre-approval (known as “prior authorization”) for certain types of power wheelchairs before Medicare will cover the cost. If you need pre-approval, your DME supplier can submit a prior authorization request and all documentation to Medicare for you. Medicare will then review the information to make sure you meet all the requirements for power wheelchair coverage.6

A Medicare Supplement (Medigap) plan may help cover the out-of-pocket costs for your wheelchair, such as Medicare deductibles and copays. You may have to pay an additional premium for a Medicare Supplement insurance plan.

Medicare gives you a choice to rent or buy certain items, including most wheelchairs. For more expensive equipment like wheelchairs, Medicare will pay to rent the item for 13 months of continuous use. Part B covers 80% of the cost of a monthly rental fee for 13 months and you pay a 20% coinsurance. After the 13th month of rental ends, the supplier must transfer ownership of the wheelchair to you.7

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Sources

  1. “Medicare’s Wheelchair & Scooter Benefit,” Medicare.gov, last accessed Jan. 31, 2024, https://www.medicare.gov/Pubs/pdf/11046-Medicare-Wheelchair-Scooter.pdf, PDF.
  2. “Medicare’s Wheelchair & Scooter Benefit.”
  3. “Medicare’s Wheelchair & Scooter Benefit.”
  4. “How to file an appeal,” Medicare.gov, last accessed Jan. 31, 2024, https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal.
  5. “Durable medical equipment (DME) coverage,” Medicare.gov, last accessed Jan. 31, 2024, https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage.
  6. “Medicare’s Wheelchair & Scooter Benefit.”
  7. “Medicare Coverage of Durable Medical Equipment & Other Devices,” Medicare.gov, last accessed Jan. 31, 2024, https://www.medicare.gov/media/publication/11045-medicare-coverage-of-dme-and-other-devices.pdf, PDF.