Navigating new medical expenses—like purchasing a wheelchair—can be emotionally and financially overwhelming. While many older adults rely on Medicare, understanding what it covers (and what it doesn’t) can feel like just another daunting item on the to-do list.
We’ve done the research for you to help clarify whether Medicare can help cover the cost of your new wheelchair and to explore other ways you might reduce out-of-pocket expenses.
Understanding Medicare’s Role
Medicare is the federal health insurance program for people age 65 and older, as well as some younger individuals with disabilities. It often plays a vital role in covering essential medical equipment, including durable medical equipment (DME) like wheelchairs.
However, Medicare coverage is not automatic. There are specific requirements that must be met, and not every type of wheelchair or feature is included—something that can leave older adults and their families facing unexpected costs.
In this guide, we’ll walk you through how Medicare coverage for wheelchairs works: eligibility requirements, types of wheelchairs covered, what Medicare will pay, the steps to get coverage, and what to do if you’ve already purchased or need to replace a wheelchair.
Who Is Eligible for Medicare Coverage?
To qualify for Medicare wheelchair coverage, you must:
- Be enrolled in Medicare Part B, which covers medically necessary services and durable medical equipment.
- Have a face-to-face visit with a Medicare-enrolled physician who documents that a wheelchair is medically necessary.
- Need the wheelchair for use inside the home, due to a condition that makes it difficult or impossible to move around safely without it.
Conditions that may qualify include arthritis, multiple sclerosis, neurological disorders, and other mobility-limiting illnesses. Some individuals may need a wheelchair temporarily—for instance, while recovering from a stroke—while others may need one long-term.
What Types of Wheelchairs Does Medicare Cover?
Medicare typically covers two main types of wheelchairs:
- Manual Wheelchairs: These are self-propelled or pushed by a caregiver. Medicare may cover them if you can’t use a cane or walker
- Power Wheelchairs: These are battery-powered and controlled with a joystick or similar device. They’re covered when manual wheelchairs aren’t sufficient due to more serious mobility limitations.
To qualify for either type, the wheelchair must be medically necessary for in-home use, and you must get a prescription from a Medicare-enrolled physician.
Medicare generally only covers the basic models that meet your medical needs. Any upgrades or extra features may need to be paid out-of-pocket.
Not sure what kind of wheelchair you need? Check out our guide to choosing the best wheelchairs for seniors.
How Much Does Medicare Pay for a Wheelchair?
If you’re enrolled in Original Medicare (Part A and Part B), Medicare Part B usually covers 80% of the Medicare-approved amount for the wheelchair after you’ve met your annual deductible (which is $240 in 2024). You are typically responsible for the remaining 20%.
If you have a Medicare Advantage Plan (Part C), your coverage may differ slightly. These plans must offer the same benefits as Original Medicare but may have their own rules and cost-sharing requirements. Be sure to check with your plan provider for details.
How to Get a Wheelchair Covered by Medicare
- See a Healthcare Provider
Schedule an appointment with a Medicare-enrolled doctor or therapist who can assess your mobility needs. - Get a Prescription
If medically necessary, your provider will issue a written prescription specifying the type of wheelchair required. - Choose a Medicare-Approved Supplier
Make sure to purchase your wheelchair from a supplier who accepts Medicare. They will help with billing and paperwork. - Submit the Claim
The supplier typically handles this step, including submitting the prescription and required documentation (like a Certificate of Medical Necessity). - Pay Your Share
After Medicare pays its portion, you’ll be responsible for the rest—usually 20%, unless you have supplemental insurance that covers it.
What If You’ve Already Bought a Wheelchair?
If you’ve already purchased a wheelchair without going through Medicare’s approval process, you may still be able to get reimbursed—but only if you meet certain criteria:
- Ensure Eligibility
The wheelchair must meet Medicare’s medical necessity requirements. - Gather Documentation
Collect all necessary paperwork, including the doctor’s prescription and proof of medical necessity. - Submit a Reimbursement Request
Work with your supplier to submit the claim to Medicare, along with all required documents. - Wait for Processing
Medicare will review your claim and, if approved, reimburse you based on the Medicare-approved amount for that type of wheelchair.
Need a Replacement Wheelchair?
Medicare may cover the cost of a replacement wheelchair if:
- Your existing chair is damaged beyond repair.
- It has been lost or stolen.
- Your medical needs have changed, requiring a different type of wheelchair.
To start the process:
- Consult Your Doctor Again
Get reassessed and obtain a new prescription. - Follow the Same Process as for a New Wheelchair
Choose a Medicare-approved supplier and ensure all documentation is submitted. - Include a Statement of Need
When requesting a replacement, you or your doctor must explain why the old wheelchair is no longer suitable. - Wait for Medicare’s Approval
Once approved, Medicare will cover the replacement cost according to its guidelines.
Understanding Medicare’s wheelchair coverage can feel complicated, but knowing the process—and following the right steps—can help you access the equipment you need without unexpected financial burdens.
Whether you’re purchasing a new wheelchair, seeking reimbursement, or replacing an old one, working closely with your healthcare provider and a Medicare-approved supplier is key. With the right documentation and support, Medicare can be a valuable resource in meeting your mobility needs.
