Medicare covers wheelchairs, but only certain types under specific conditions

Medicare Part B covers manual wheelchairs, motorized wheelchairs (called power wheelchairs), and scooters, but only when a doctor prescribes them as medically necessary. You pay 20% of the approved amount after you meet your Part B deductible. The wheelchair must come from a Medicare-approved supplier — not any medical equipment company.

What Medicare will not cover: wheelchairs you buy for convenience, lightweight travel chairs, or any device ordered without a doctor's prescription. If you already own a wheelchair, Medicare will not pay for a replacement unless your medical condition has changed significantly or the old one is no longer usable.

The approval process takes time. Your doctor must document why you need the wheelchair, submit it to Medicare, and Medicare reviews it before you can order. This usually takes one to two weeks, though it can be longer if Medicare asks for more information.

Key Takeaways

  • Your doctor must prescribe the wheelchair and document that it is medically necessary for your condition.
  • You must order from a Medicare-approved supplier, which you can find on Medicare.gov or by calling 1-800-MEDICARE.
  • You pay 20% of the Medicare-approved amount after meeting your Part B deductible; the supplier bills Medicare for the rest.
  • Medicare covers manual wheelchairs, power wheelchairs, and scooters, but not lightweight travel models or devices ordered without a prescription.
  • The approval process typically takes one to two weeks from the time your doctor submits the prescription.

How to get your doctor to prescribe a wheelchair

Start by telling your doctor that you are having trouble walking or moving around your home or community. Be specific: do you fall frequently, does walking cause pain, can you only walk short distances before needing to rest? The more detail you give, the easier it is for your doctor to justify the prescription to Medicare.

Your doctor will examine you and may ask questions about your daily activities — whether you can get to the bathroom safely, whether you can shop or go to appointments. They will then write a prescription that includes the type of wheelchair (manual or power) and the reason you need it. This prescription goes to a Medicare-approved supplier, not to you.

If your doctor is unsure whether Medicare will cover it, ask them to submit the prescription anyway. Medicare makes the final decision, not your doctor. If Medicare denies it, you have the right to appeal.

Finding a Medicare-approved wheelchair supplier

You cannot order a wheelchair from any company and have Medicare pay for it. The supplier must be enrolled in Medicare. To find one near you, go to Medicare.gov and use the "Supplier Directory" tool, or call 1-800-MEDICARE and ask for suppliers in your area.

When you call a supplier, tell them you have a prescription from your doctor and ask if they are Medicare-approved. Ask them to confirm your address and insurance information before they contact your doctor for the prescription. A good supplier will handle most of the paperwork for you.

You can use any Medicare-approved supplier — you are not limited to one in your town. If the local supplier has a long wait or does not stock the model your doctor prescribed, you can order from a supplier in another state.

What you will pay out of pocket

Your cost depends on the type of wheelchair and the Medicare-approved amount for that item in your area. For a manual wheelchair, the approved amount is usually between $800 and $1,200. For a power wheelchair, it is typically $4,000 to $6,000, though this varies by region and the specific features.

You pay 20% of the approved amount after you have met your Part B deductible for the year. If you have not met your deductible yet, you pay the full deductible first, then 20% of the wheelchair cost. If you have already met your deductible, you pay only the 20%.

Some Medigap or Medicare Advantage plans cover part or all of the 20% coinsurance. Check your plan documents or call your plan to see what your wheelchair coverage is.

Manual wheelchairs versus power wheelchairs

Medicare covers both, but your doctor must explain why you need one type over the other. A manual wheelchair requires you to push the wheels yourself. Medicare covers this if you have the arm strength and coordination to propel it, even if you cannot walk. Manual wheelchairs are lighter, easier to transport, and less expensive.

A power wheelchair is motorized and controlled by a joystick or other device. Medicare covers this if you cannot propel a manual wheelchair yourself — for example, if you have severe arthritis in your hands, limited arm strength, or a neurological condition that affects coordination. Power wheelchairs are heavier and more expensive, but they allow people with limited upper-body strength to move independently.

A scooter (three- or four-wheeled motorized device) is covered if you can walk short distances but need a motorized seat for longer trips. Scooters are typically cheaper than power wheelchairs and easier to transport, but they require more balance and coordination to operate safely.

What happens if Medicare denies your wheelchair

If Medicare says no, you will receive a letter called a "Notice of Non-Coverage" or "Explanation of Benefits" that explains why. Common reasons for denial: your doctor did not provide enough medical justification, the wheelchair was not prescribed by a doctor, or Medicare determined the device is not medically necessary for your condition.

You have the right to appeal. You can ask your doctor to provide more information about your condition and resubmit the prescription, or you can file a formal appeal with Medicare. The appeal process has several levels, and you can request a hearing if you disagree with the decision. Call 1-800-MEDICARE to ask about the appeal process for your specific situation.

While you appeal, you can buy a wheelchair out of pocket if you need one when ready. If Medicare approves your appeal later, you may be reimbursed for part of the cost, though this depends on the timing and your plan.

Repairs, replacement parts, and maintenance

Medicare covers repairs and replacement parts for a wheelchair that Medicare paid for, as long as the repair is medically necessary and the wheelchair cannot be fixed any other way. For example, if the wheel breaks, Medicare may cover a replacement wheel. If the frame cracks and cannot be welded, Medicare may cover a new wheelchair.

You cannot get a new wheelchair just because the old one is worn out or outdated. Medicare will only pay for a replacement if your medical condition has changed, the old wheelchair is no longer usable, or you have had the same wheelchair for five years or more (in some cases).

Routine maintenance — like cleaning, lubricating wheels, or adjusting the seat — is your responsibility. The supplier may offer these services for a fee, or you can learn to do basic maintenance yourself.

Frequently Asked Questions

Can I get a wheelchair if I am in a nursing home or assisted living?

If you are in a Medicare-certified nursing home, the facility usually provides wheelchairs as part of your care. Medicare does not pay for a personal wheelchair while you are there. If you move to assisted living or return home, you can then request a prescription from your doctor and have Medicare cover a wheelchair for your personal use.

What if my doctor says I do not need a wheelchair but I think I do?

You can ask your doctor to refer you to a physical therapist or occupational therapist for an evaluation. These specialists can assess your mobility and make a recommendation to your doctor. If your doctor still disagrees, you can seek a second opinion from another doctor. Medicare will not override your doctor's medical judgment.

Does Medicare cover wheelchair cushions, ramps, or lifts?

Medicare covers some wheelchair cushions if they are medically necessary — for example, a pressure-relief cushion to prevent bedsores. Ramps and lifts are covered under different Medicare rules and depend on whether they are considered home modifications or durable medical equipment. Ask your doctor or supplier which items are covered under your situation.

Can I upgrade to a fancier wheelchair model if I pay the difference?

Yes. Medicare pays for the standard model approved in your area. If you want a lighter frame, better wheels, or other upgrades, you can pay the difference yourself. The supplier can show you what the Medicare-covered model includes and what upgrades cost extra.

What if I move to a different state?

Medicare coverage rules are the same nationwide, but the approved amount for wheelchairs varies by region. If you move, you can continue using your current wheelchair. If you need a new one, your new doctor can prescribe it and you can order from a Medicare-approved supplier in your new state. The approved amount may be different, which could affect your out-of-pocket cost.