Medicare is the federal health insurance program for individuals 65 and older, individuals with disabilities, and those with end-stage renal disease. There are different parts of Medicare, each of which covers a different type of medical care. Medicare Part B, known as medical insurance, covers durable medical equipment, which includes wheelchairs.

If you’re planning to request a wheelchair through Medicare, it’s important to understand what’s required, the process to have your request approved, and how much you can expect to pay.

Key Takeaways

  • Medicare Part B covers the cost of wheelchairs, as long as you have the necessary documentation from your doctor.
  • Depending on the situation, Medicare might pay for either a power or manual wheelchair and either a purchase or a rental.
  • Once you’ve met your Medicare Part B deductible, Medicare will pay for 80% of your wheelchair, while you’ll pay for the other 20%.
  • If Medicare denies your wheelchair request, you can either resubmit your documentation or appeal the decision.

Does Medicare Pay for Wheelchairs?

Medicare Part B (medical insurance) covers durable medical equipment, which includes wheelchairs. Generally speaking, Medicare will cover your wheelchair if your doctor submits a written order stating that you need one and that you have limited mobility with all of the following conditions:1

  • A health condition that makes it difficult to move around your home
  • An inability to do activities of daily living
  • An ability to safely operate a wheelchair, including getting on and off (or you have someone who can help you do so)
  • A doctor and wheelchair supplier who both accept Medicare
  • A doctor or supplier who has visited your home to verify you can use a wheelchair there

Note

If you can’t safely operate a wheelchair, Medicare instead may approve you for a power-operated scooter. To be eligible, you must be able to sit up, operate the controls, and get in and out of the scooter.

Power vs. Manual Wheelchairs

Medicare Part B covers both power and manual wheelchairs. However, not everyone will be eligible for both. To qualify for either a power or manual wheelchair, you’ll need a written statement from your doctor stating that you need one.2 You’ll only qualify to have your power wheelchair covered if it's deemed to be medically necessary.

Note

Even if your doctor states you need a power wheelchair, Medicare could decide otherwise. If you don’t qualify for a power wheelchair, you may still qualify for a manual one.

Buying vs. Renting

Depending on your situation, you may be able to either rent or buy medical equipment. In some cases, Medicare will decide which is most appropriate for your situation. In other cases, you may be able to decide whether to buy or rent.

Generally speaking, Medicare only buys inexpensive equipment such as canes and walkers. For other equipment, it defaults to renting. However, after 13 consecutive months of renting, it will switch from a rental to a purchase.3

Another situation where Medicare might buy your equipment is if you already own a covered device. In that case, Medicare may pay to repair your device or replace individual parts. Medicare may also replace your equipment if it's lost, stolen, or damaged beyond repair.

How To Get Medicare To Pay for Your Wheelchair

If you’re trying to qualify for a wheelchair through your Medicare coverage, it’s important that you follow the appropriate steps.1

  1. Get a Written Order From Your Doctor

    This written order should state that you have a medical need for the wheelchair.

    Note

    Before asking your doctor for a written order for a wheelchair, make sure your doctor accepts Medicare. Otherwise, your wheelchair purchase or rental won’t be covered.

  2. Request Prior Authorization

    First, you’ll have to request prior authorization from a medical equipment supplier that accepts Medicare. Once you’ve done that, you’ll send the prior authorization to Medicare so they can make their final decision.

  3. Get Approval for Your Wheelchair

    Once you’ve submitted your written order and prior authorization to Medicare, you’ll receive a decision letter letting you know whether your request has been approved. If you have questions about their decision or haven’t received a letter, call Medicare at 1-800-MEDICARE.

How To Appeal a Denial of Coverage

Even with a written order from your doctor and prior authorization from your supplier, Medicare could still deny your request. This is likely to happen if Medicare either finds you don’t medically require a wheelchair or didn’t receive enough information to make a decision.

If Medicare denies your request and you disagree with the decision, you still have some options. First, resubmit your prior authorization. If that doesn’t work, follow the Original Medicare appeals process. Here’s how to file your appeal:4

  1. File your appeal by the date listed in your Medicare Summary Notice.

  2. Submit your appeal in one of the following ways:

    • Fill out the “Redetermination Request Form” and send it to the company that handles your Medicare claims.
    • Send a written request to the company that handles your Medicare claims.

  3. In your claim, include the following information:

    • Your name, address, and Medicare number
    • The decision you’re appealing
    • Why you’re appealing the decision
    • The name of your appointed representative, if you have one
    • Any other information that may help your case

What Costs You Need To Cover

If Medicare approves your request for a wheelchair, you’ll still be on the hook for some costs. First, you’ll have to meet your deductible for the year. For 2022, the Medicare Part B deductible is $233. Once you’ve met your Medicare Part B deductible, you’ll pay a 20% coinsurance for durable medical equipment, including wheelchairs. Medicare will pay for the other 80%.5

Note

The 20% coinsurance only applies to the Medicare-approved cost, which is the lower of the set Medicare fee or the actual cost of the item.6

The Bottom Line

Wheelchairs are covered under Medicare Part B as a part of the coverage for durable medical equipment. You’ll qualify if you have a health condition that requires a wheelchair and your doctor provides a written order for one. The requirements may be slightly different depending on whether you’re requesting a manual or power wheelchair. As a result, it’s important to research the process ahead of time to improve your chances of having your request approved the first time.

Frequently Asked Questions (FAQs)

What brands of electric wheelchairs does Medicare cover?

Medicare covers 40 different models of power wheelchairs.7 These wheelchairs fall into nine different groups and have weight limits ranging from 300 pounds to more than 600 pounds.

How do you sign up for Medicare?

If you’ve applied for Social Security retirement benefits, then you’ll automatically be signed up for Medicare Part A and Part B. If you aren’t automatically enrolled, you can sign up for Medicare by contacting the Social Security Administration.8

What is the Medicare deductible for 2022?

There are different Medicare deductibles for different parts and services. Medicare Part A has a deductible of $1,556 for each benefit period when you’re admitted for inpatient care in the hospital. Medicare Part B has a deductible of $233 per year.5

How much does Medicare cost?

Medicare Part A is free for most enrollees. You’ll qualify for premium-free Medicare Part A if you or your spouse meet the work requirements to qualify for Social Security retirement benefits. If you don’t meet those requirements, you’ll pay a premium of either $274 or $499, depending on the amount of Medicare taxes you or your spouse paid when working.5 Medicare Part B has a standard premium of $170.10, but the cost may be higher for enrollees with a high annual income.