How Medicare covers wheelchairs

Medicare Part B covers manual wheelchairs, power wheelchairs, and scooters if a doctor prescribes them as medically necessary. You do not pay the full cost upfront — instead, you pay 20 percent of the approved amount after you meet your Part B deductible, and Medicare pays the rest. The supplier you choose must be enrolled with Medicare, which means they have agreed to accept Medicare's payment as the standard rate.

The wheelchair itself is considered durable medical equipment (DME), the same category that covers walkers, hospital beds, and oxygen machines. Medicare does not cover the wheelchair as a one-time purchase — instead, it covers a rental or purchase depending on how long you are likely to need it. If you will need the wheelchair for less than 13 months, Medicare typically covers rental. If you will need it longer, Medicare may cover purchase instead.

Key Takeaways

  • Your doctor must write a prescription stating that a wheelchair is medically necessary for your condition, and the prescription must be recent enough that Medicare will accept it.
  • You must use a Medicare-enrolled DME supplier, not a general medical supply store, because only enrolled suppliers can bill Medicare directly.
  • Medicare covers either rental or purchase depending on how long you need the wheelchair, and you pay 20 percent of the approved amount after your Part B deductible.
  • The approval process usually takes one to two weeks after the supplier submits your prescription and medical records to Medicare for review.

Getting a prescription from your doctor

Start by asking your doctor whether a wheelchair is medically necessary for your condition. Your doctor does not have to write the prescription during your visit — you can call their office afterward and ask them to send one to a DME supplier you choose. The prescription must include your diagnosis, why you need the wheelchair, and what type of wheelchair (manual, power, or scooter).

Medicare requires that the prescription be written by a doctor, nurse practitioner, or physician assistant who has seen you in person within the past six months. A telehealth visit counts as an in-person visit for this purpose. If your last visit was longer than six months ago, you will need a new appointment before your doctor can write the prescription.

Keep a copy of the prescription for your records. You will need it if you change suppliers or if Medicare asks for proof later.

Finding a Medicare-enrolled DME supplier

Not every medical supply store is enrolled with Medicare. You can search for enrolled suppliers in your area using the Medicare Supplier Directory at dmepos.cms.gov, or you can call 1-800-MEDICARE and ask them to give you names of suppliers near you. When you call a supplier, ask them directly: "Are you enrolled with Medicare to bill for durable medical equipment?"

Once you have found a supplier, give them your doctor's prescription. They will ask for your Medicare card and will verify your coverage. They will also ask whether you want to rent or purchase the wheelchair — if you are unsure, they can tell you what Medicare typically covers for your situation. Do not assume the supplier will handle everything; ask them what documents they need from you and what happens next.

Some suppliers are better than others at following up with Medicare. If a supplier seems slow to respond or unclear about the process, you can switch to a different enrolled supplier at any time.

What happens after you choose a supplier

The supplier will submit your prescription and medical records to Medicare for review. This is called a prior authorization — Medicare is checking that the wheelchair meets their rules before they agree to pay. The review usually takes one to two weeks.

During this time, do not buy or rent the wheelchair on your own. Wait for Medicare's approval. If you buy it before approval and Medicare denies the claim, you will owe the full cost.

Medicare may ask your doctor for more information, or they may ask you questions directly. If Medicare contacts you, answer their questions promptly. If you do not respond, they may deny the claim.

What you pay

Once Medicare approves the wheelchair, the supplier will tell you what your cost will be. You pay 20 percent of the Medicare-approved amount after you have met your Part B deductible for the year. If you have already met your deductible, you pay 20 percent right away. If you have not met it yet, you pay the full deductible first, then 20 percent of the approved amount.

The approved amount is set by Medicare, not by the supplier. Different suppliers may charge different prices, but Medicare will only pay based on the approved amount. If a supplier charges more than the approved amount, they cannot ask you to pay the difference — that is called balance billing, and it is not allowed.

If you have a Medigap or Medicare Advantage plan, your plan may cover some or all of your 20 percent cost. Check your plan documents or call your plan to ask what they cover for wheelchairs.

If Medicare denies your claim

Medicare may deny your claim if your doctor's prescription does not meet their rules, if your condition does not meet their medical necessity standard, or if the wheelchair type you requested is not covered. The supplier will send you a notice called an Explanation of Benefits (EOB) that explains why Medicare denied the claim.

You have the right to ask Medicare to reconsider. This is called an appeal. You must file your appeal within 180 days of the denial date on your EOB. You can ask your doctor to provide additional medical information to support your case, or you can ask the supplier to resubmit with more detail. Many appeals are successful because the first submission was incomplete.

If you need help with an appeal, you can contact your State Health Insurance information Program (SHIP) for free. Call 1-800-MEDICARE and ask for your state's SHIP phone number.

Repairs, replacements, and upgrades

If your wheelchair breaks and needs repair, Medicare covers the repair if you are still renting. If you own the wheelchair, Medicare does not cover repairs — that is your responsibility. However, Medicare may cover a replacement wheelchair if your condition changes and you need a different type.

If you want to upgrade to a more expensive wheelchair model, Medicare will only pay for the approved amount. You can pay the difference out of pocket if you choose, but the supplier cannot pressure you to do so.

Frequently Asked Questions

Can I use any wheelchair, or does it have to be a specific brand?

Medicare does not require a specific brand. Any wheelchair that meets Medicare's standards and is prescribed by your doctor can be covered. The supplier will help you choose a wheelchair that fits your needs and that Medicare will cover.

What if I need a wheelchair right away and cannot wait for approval?

You can rent or buy a wheelchair on your own while waiting for Medicare approval. However, if Medicare denies the claim, you will not be reimbursed. Ask the supplier whether they will hold your payment pending Medicare's decision, or whether they can bill you after approval instead.

Do I have to use the supplier Medicare recommends?

No. You can choose any Medicare-enrolled DME supplier. Medicare does not recommend specific suppliers. Make sure whoever you choose is enrolled with Medicare before you give them your prescription.

What if I rent the wheelchair and then decide I want to buy it?

You can switch from rental to purchase, but Medicare will count the rental payments you have already made toward the purchase price. Talk to your supplier about how this works before you decide.

Does Medicare cover wheelchair accessories like cushions or ramps?

Some accessories are covered if your doctor prescribes them as medically necessary. Cushions for pressure relief and certain safety equipment may be covered. Ask your doctor and your supplier what accessories Medicare covers for your situation.