What Medicare will pay for and what you have to do

Medicare Part B covers wheelchairs, but only if a doctor writes an order saying you need one for your home. Medicare calls these items Durable Medical Equipment, or DME. The wheelchair has to be medically necessary — meaning your condition makes walking unsafe or impossible — and a doctor has to document that in your medical record before you shop.

Medicare pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent. The exact cost depends on the type of wheelchair and the supplier you choose, because Medicare sets a maximum it will reimburse, and different suppliers charge different amounts up to that limit.

The process takes time. Your doctor's order, the supplier's paperwork, and Medicare's review can take four to six weeks from start to delivery. If you need a wheelchair urgently, ask your doctor whether a temporary rental is covered while you wait for approval of a purchase.

Key Takeaways

  • Your doctor must write an order stating that a wheelchair is medically necessary for your condition and document this in your medical record before you contact a supplier.
  • You must use a Medicare-approved DME supplier, and the supplier handles submitting paperwork to Medicare on your behalf.
  • Medicare pays 80 percent of the approved amount after your Part B deductible is met, and you are responsible for the remaining 20 percent.
  • The entire process from doctor's order to delivery typically takes four to six weeks.
  • Manual wheelchairs are usually covered; power wheelchairs require additional documentation proving you cannot operate a manual chair safely.

Getting your doctor to write the order

Start by talking to your primary care doctor or the specialist treating your condition. Explain that you are having trouble walking safely at home and ask whether a wheelchair would help. The doctor does not have to agree — the decision is theirs based on your medical situation.

If your doctor agrees, they will write a written order that includes your diagnosis, why the wheelchair is necessary, and what type (manual, power, or specialized). This order goes into your medical record. Some doctors' offices send the order directly to a DME supplier; others give you a copy to take yourself. Ask which way your doctor's office handles it.

If your doctor is unsure or declines, you can ask for a second opinion from another doctor. Medicare will cover the wheelchair based on any doctor's order, as long as that doctor has examined you and documented the medical need.

Choosing a Medicare-approved supplier

You must buy or rent from a supplier that Medicare has approved. You can find these suppliers by calling Medicare at 1-800-MEDICARE or by searching the Medicare Supplier Directory online at dmepos.cms.gov. The directory lets you search by your zip code and shows which suppliers are approved in your area.

Call at least two or three suppliers and ask what they charge for the type of wheelchair your doctor ordered. Medicare sets a maximum reimbursement amount, but suppliers can charge less. If a supplier charges more than Medicare's limit, you would owe the difference — so comparing prices matters.

When you contact a supplier, have your doctor's order ready and ask them to explain their process for submitting to Medicare. Most suppliers handle all the paperwork; you should not have to contact Medicare yourself. Confirm that the supplier is in-network for your Medicare plan if you have a Medicare Advantage plan, because out-of-network suppliers may charge you more.

What happens after you choose a supplier

The supplier will ask for your Medicare number, your doctor's order, and sometimes additional medical information. They may also ask you to sign a form saying you understand you will owe 20 percent of the cost. The supplier then submits everything to Medicare for review.

Medicare reviews the paperwork to confirm that the wheelchair is medically necessary and that the supplier is approved. This review usually takes one to two weeks. If Medicare approves it, the supplier will contact you to schedule a fitting or delivery. If Medicare denies it, the supplier will tell you why and may ask your doctor for more information.

Once Medicare approves the claim, the supplier delivers the wheelchair and fits it to you. You pay your 20 percent share at that time or according to a payment plan the supplier offers.

Manual wheelchairs versus power wheelchairs

Medicare covers both manual and power wheelchairs, but power wheelchairs require more documentation. For a manual wheelchair, your doctor's order stating that you need one for safety at home is usually enough.

For a power wheelchair, Medicare requires your doctor to document that you cannot operate a manual wheelchair safely — for example, because of weakness, arthritis, or a neurological condition that affects your hands or arms. Your doctor may also need to note that you have a caregiver at home or that your home layout allows for a power chair. Medicare is stricter about power wheelchairs because they cost more.

If your doctor thinks a power wheelchair is necessary, ask them to be specific in the order about why a manual chair will not work for you. This makes approval more likely.

What to do if Medicare denies your claim

If Medicare denies the wheelchair, the supplier will send you a notice explaining the reason. Common reasons include: the doctor's order did not clearly state medical necessity, the supplier was not approved, or Medicare determined the wheelchair was not medically necessary based on your diagnosis.

You have the right to ask Medicare to reconsider. This is called a redetermination. You or your doctor can request it in writing within 180 days of the denial. Include any additional medical information that supports the need for the wheelchair — for example, a letter from your doctor explaining your condition in more detail, or notes from physical therapy showing that you fall or have difficulty walking.

Your doctor can also contact Medicare directly to discuss the denial. Sometimes a phone call from the doctor's office clarifies the medical need and leads to approval without a formal appeal.

Renting versus buying

Medicare covers both rental and purchase of wheelchairs. For a short-term need — for example, while you recover from surgery — rental may make sense. For a long-term or permanent need, purchase is usually more economical because Medicare rental payments eventually add up to the purchase price.

If you rent, Medicare pays the supplier a monthly rental fee, and you pay 20 percent of that fee. After a certain number of months (usually 13 months for a standard manual wheelchair), the wheelchair becomes yours and rental payments stop. If you buy outright, you pay 20 percent of the purchase price upfront.

Ask your supplier which option costs less in your situation. The supplier can calculate both scenarios for you.

Frequently Asked Questions

Does my Medicare Advantage plan cover wheelchairs the same way Original Medicare does?

Medicare Advantage plans must cover wheelchairs at least as well as Original Medicare does, but some plans have additional rules — for example, requiring prior approval or limiting which suppliers you can use. Call your plan's customer service number to ask about their specific wheelchair coverage before you contact a supplier.

What if I need a wheelchair faster than four to six weeks?

Ask your doctor whether a temporary rental wheelchair can be covered while you wait for approval of a purchase. Some suppliers rent wheelchairs on a short-term basis. You can also rent a wheelchair from a non-Medicare supplier out of pocket and then switch to the Medicare-covered chair once it arrives.

Will Medicare cover a wheelchair cushion or other accessories?

Yes, Medicare covers certain wheelchair accessories and cushions if they are medically necessary and your doctor orders them. Pressure-relief cushions, armrests, and footrests are often covered. Ask your supplier which accessories are included in the wheelchair price and which are billed separately.

What if the wheelchair does not fit properly or I need adjustments?

Contact your supplier. They are responsible for fitting the wheelchair to you and making adjustments during the first period of use. If the wheelchair is defective or does not meet your needs, the supplier should work with you to fix it or, in some cases, provide a different model. Medicare covers these adjustments as part of the original claim.

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

Medicare covers standard manual and power wheelchairs that meet medical necessity. Specialized or custom wheelchairs — for example, sports wheelchairs or those with unusual features — may not be covered. Your doctor's order and the supplier's assessment determine what type Medicare will pay for based on your condition and home environment.