Medicare covers wheelchairs and other mobility devices, but only certain types under specific conditions

Medicare Part B covers manual wheelchairs, motorized wheelchairs, and scooters when a doctor prescribes them as medically necessary. You typically pay 20% of the approved amount after you meet your Part B deductible; Medicare pays the remaining 80%. The device must come from a Medicare-approved supplier, and your doctor must document that you cannot walk safely without it or that walking would be unsafe or impossible for you.

Not every wheelchair or scooter qualifies. Medicare distinguishes between different mobility devices and has specific rules about which ones it will cover. A standard manual wheelchair is more likely to be covered than a high-end sports wheelchair. A motorized scooter is covered if you cannot use a manual wheelchair, but a power wheelchair requires stronger medical justification than a scooter does.

The approval process takes time. Your doctor submits a prescription and medical documentation to a Medicare-approved supplier. The supplier then requests prior authorization from Medicare. This step can take one to two weeks, and Medicare may deny the request if the documentation does not meet their standards. If Medicare denies coverage, you have the right to appeal.

Key Takeaways

  • Medicare Part B covers manual wheelchairs, motorized wheelchairs, and scooters when a doctor prescribes them as medically necessary and documents that you cannot walk safely without one.
  • You pay 20% of the Medicare-approved amount after your Part B deductible; the device must come from a Medicare-approved supplier.
  • Your doctor's prescription and medical records must show that the specific type of device you need is necessary for your safety and mobility.
  • The approval process typically takes one to two weeks, and Medicare may deny coverage if documentation is incomplete or does not meet their standards.
  • If Medicare denies your request, you can file an appeal with supporting medical evidence from your doctor.

What types of wheelchairs and mobility devices Medicare covers

Medicare covers three main categories of mobility devices: manual wheelchairs, motorized wheelchairs (also called power wheelchairs), and motorized scooters. A manual wheelchair is the least expensive and is covered when you have a condition that prevents you from walking safely. A motorized scooter is covered when you can transfer yourself (move from bed to chair, for example) but cannot walk far enough to meet your daily needs. A power wheelchair is covered when you cannot operate a manual wheelchair and cannot use a scooter safely.

Medicare also covers certain accessories and replacement parts, such as cushions, armrests, footrests, and tires, but only if they are medically necessary and not just for comfort or convenience. Replacement cushions are covered more readily than custom seating systems, which require additional medical justification. Batteries for motorized devices are covered as replacement parts, not as initial equipment.

Devices that Medicare does not cover include standing wheelchairs, all-terrain wheelchairs, and recreational mobility devices. Lightweight or sports wheelchairs designed for athletics are not covered. Stair-climbing wheelchairs and other specialized devices fall outside Medicare's coverage rules. If your doctor prescribes one of these devices, you would pay the full cost yourself.

How to get Medicare approval for a wheelchair

Start by talking with your doctor about your mobility needs. Your doctor must examine you and determine that a wheelchair or scooter is medically necessary for your safety. The doctor then writes a prescription that specifies the type of device (manual wheelchair, power wheelchair, or scooter) and the medical reason you need it. The prescription must include details about your condition and why you cannot walk safely or far enough without the device.

Next, contact a Medicare-approved supplier in your area. You can find approved suppliers by visiting Medicare.gov and using their supplier search tool, or by calling 1-800-MEDICARE. The supplier will review your prescription and medical records. If they believe your case meets Medicare's requirements, they submit a prior authorization request to Medicare on your behalf. You do not need to submit this request yourself; the supplier handles it.

Medicare reviews the request and typically responds within one to two weeks. If approved, the supplier orders or builds your device and arranges delivery and fitting. If Medicare denies the request, the supplier will notify you in writing and explain the reason. At that point, you can ask your doctor for additional medical documentation and file an appeal, or you can purchase the device yourself and pay out of pocket.

What you pay for a wheelchair under Medicare

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. Once you meet the deductible, Medicare pays 80% of the approved amount for the wheelchair or scooter, and you pay 20%. The approved amount is set by Medicare, not by the supplier's asking price. If a supplier charges more than Medicare's approved amount, you are responsible only for 20% of the approved amount, not 20% of the supplier's higher price.

The approved amount varies by device type and region. A manual wheelchair typically has a lower approved amount than a motorized scooter, which has a lower approved amount than a power wheelchair. You can ask the supplier what Medicare's approved amount is for the specific device your doctor prescribed before you proceed. This helps you understand your 20% cost share in advance.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower. Some Medigap plans cover part or all of the 20% you would normally pay. Medicare Advantage plans vary in their coverage of durable medical equipment. Review your plan documents or call your plan to find out what your actual cost will be.

What happens if Medicare denies your wheelchair request

Medicare denies wheelchair requests most often because the medical documentation does not clearly show that the device is medically necessary, or because the type of device requested does not match the person's medical condition. For example, if you request a power wheelchair but your medical records show you can transfer yourself and walk short distances, Medicare may approve only a scooter instead. If you request a motorized device but your records do not show that a manual wheelchair would be unsafe for you, Medicare may deny the motorized option.

When Medicare denies your request, you receive a written notice that explains the specific reason. You have 120 days from the date of the denial to file an appeal. To appeal, ask your doctor to provide additional medical evidence that supports the need for the device Medicare denied. This might include notes from a physical therapist, results of mobility tests, or a detailed letter from your doctor explaining why the denied device is necessary for your safety.

You submit the appeal along with the new medical evidence to Medicare. An independent reviewer who was not involved in the original decision will look at your case. This process can take several weeks. If the appeal is approved, Medicare will cover the device. If it is denied again, you have further appeal options, but they involve more time and complexity. Your doctor or the supplier can help you understand your appeal rights.

Renting versus buying a wheelchair through Medicare

Medicare covers the purchase of a wheelchair or scooter, not rental. Once Medicare approves your device and you receive it, you own it. If your medical needs change and you no longer need the device, you cannot return it to Medicare for a refund. However, you can donate it, sell it, or give it to someone else.

Some suppliers offer rental options outside of Medicare, but Medicare will not pay for a rental. If you rent a device from a private company, you pay the full rental cost yourself. Rental can be useful if you need a device temporarily while recovering from surgery or an injury, but Medicare does not cover this temporary need.

If your condition improves and you no longer need a wheelchair, you can request a different device through Medicare after a certain period has passed. Medicare typically allows a new wheelchair or scooter every five years, unless your medical condition changes significantly. If you have a new condition that requires a different type of device, your doctor can request coverage for the new device sooner.

Medicare Part D and wheelchair accessories

Medicare Part D (prescription drug coverage) does not cover wheelchairs or mobility devices. Part D covers only prescription medications. Wheelchair accessories such as cushions, armrests, and footrests are covered under Part B as durable medical equipment, not under Part D.

If an accessory is covered under Part B, you pay 20% of the approved amount after your Part B deductible, just as you do for the wheelchair itself. Some accessories require a separate prior authorization request, while others are approved automatically once the main device is approved. Ask your supplier which accessories require separate approval before ordering them.

Frequently Asked Questions

Can I choose any wheelchair I want, or does Medicare limit my options?

Medicare covers the wheelchair type your doctor prescribes as medically necessary, but you can choose among approved suppliers and models within that category. If your doctor prescribes a manual wheelchair, you can select from different manual wheelchair models that Medicare approves. You cannot choose a power wheelchair if your doctor prescribes a manual one, unless you appeal and provide additional medical evidence.

What if my doctor says I need a wheelchair but Medicare says I don't?

This disagreement happens sometimes. Medicare has its own medical criteria separate from your doctor's opinion. If Medicare denies coverage, ask your doctor to write a detailed letter explaining why the wheelchair is medically necessary for your safety. Submit this letter with an appeal to Medicare within 120 days of the denial. An independent reviewer will reconsider your case.

Do I have to use a Medicare-approved supplier, or can I buy a wheelchair anywhere?

You must use a Medicare-approved supplier for Medicare to pay for the device. If you buy a wheelchair from a non-approved supplier, Medicare will not cover any part of the cost. You can find approved suppliers through Medicare.gov or by calling 1-800-MEDICARE.

How long does it take to get a wheelchair after Medicare approves it?

After Medicare approves your request, the supplier typically delivers and fits your device within one to two weeks, depending on whether it is a standard model or needs customization. Manual wheelchairs usually arrive faster than motorized devices. Ask the supplier for an estimated delivery date when your approval comes through.

If I have both Medicare and Medicaid, which one pays for my wheelchair?

Medicare is your primary payer, so Medicare pays first. Medicaid may cover costs that Medicare does not, such as the 20% you owe, depending on your state's Medicaid rules. Contact your Medicaid office to learn what additional coverage you may have for durable medical equipment.