How to Get a Medicare-Covered Wheelchair: A Step-by-Step Guide for Those in Need

For individuals with limited mobility, a wheelchair can dramatically improve daily life. Fortunately, Medicare may cover the cost of a manual or power wheelchair if specific requirements are met. Understanding the process, eligibility, and documentation needed is crucial to getting this essential equipment covered.

Who Is Eligible for a Medicare-Covered Wheelchair?

Medicare Part B covers durable medical equipment (DME), including wheelchairs, if the following conditions are met:

You have a health condition that makes it difficult to move around your home.
Your doctor submits a written order (prescription) stating that the wheelchair is medically necessary.
You are unable to use a cane or walker effectively for mobility.
You are capable of safely operating the wheelchair, or have someone available to assist you.
The equipment is primarily needed for use within your home, not just for outdoor activities.

Eligibility is determined on a case-by-case basis, and Medicare typically only covers wheelchairs when absolutely necessary for daily function.

Types of Wheelchairs Covered by Medicare

Depending on the patient's condition, Medicare may cover:

Manual Wheelchairs – For individuals who can self-propel or have a caregiver.
Power Scooters (Mobility Scooters) – Covered if you can't use a manual chair but can still safely operate a scooter.
Power Wheelchairs – Approved if you're completely unable to use a manual chair or scooter and need powered mobility indoors.

Each type requires a different level of medical documentation and review.

How to Apply and Qualify

Visit Your Doctor: Schedule an in-person exam with your primary physician or a specialist. They must evaluate your medical condition and determine whether a wheelchair is medically necessary.
Obtain a Prescription: Your doctor must complete a written order with details about your condition and why a wheelchair is needed. This documentation must meet Medicare standards.
Choose a Medicare-Approved DME Supplier: You must get your wheelchair from a supplier enrolled in Medicare. Use the Medicare Supplier Directory to find one in your area.
Submit to Medicare for Approval: Your supplier will work with Medicare to submit the claim. In some cases—particularly for power wheelchairs—prior authorization is required before Medicare will pay.
Await Decision: If approved, Medicare will typically cover 80% of the cost. You (or your supplemental insurance) will be responsible for the remaining 20%, as well as any Part B deductible.

Helpful Tips to Speed Up the Process

Use providers that accept Medicare assignment to reduce out-of-pocket costs.
Keep copies of all medical records and prescriptions for your documentation.
Ask about prior authorization requirements early, especially for powered equipment.
Consider Medigap or Medicare Advantage plans that may offer additional coverage or reduced co-pays.

Conclusion

A wheelchair can dramatically improve your independence and quality of life, and Medicare can help cover the cost—if you follow the right steps. From getting a proper medical assessment to working with an approved supplier, the process requires coordination and documentation, but the reward is well worth it. Take action today to regain mobility and peace of mind with a Medicare-covered wheelchair.

Sources

Medicare.gov – https://www.medicare.gov

Medicare Equipment Supplier Directory – https://www.medicare.gov/medical-equipment-suppliers/

Centers for Medicare & Medicaid Services – https://www.cms.gov

National Council on Aging – https://www.ncoa.org