Medicare-Covered Wheelchairs: Eligibility, Costs & Steps

If you or a loved one is considering a wheelchair, understanding how Medicare works can save time, stress, and money.

This guide explains eligibility, what’s covered (and what isn’t), the documentation Medicare needs, and the exact steps to qualify—so you can talk confidently with your doctor and supplier.

Why Medicare Covers Wheelchairs

Medicare treats wheelchairs as Durable Medical Equipment (DME) when they’re medically necessary for use in the home. Coverage isn’t based on convenience; it’s based on whether a wheelchair is required to help you safely perform essential daily activities like getting to the bathroom, preparing meals, or moving from room to room.

To approve a wheelchair, Medicare (Part B) looks for documentation that you have a health condition affecting mobility, that other mobility aids (like a cane or walker) won’t meet your needs, and that you can safely operate the equipment or have a caregiver who can assist. Wheelchairs must be primarily for in‑home use; Medicare won’t cover devices meant mainly for outdoor recreation or community distances.

Bottom line: if a wheelchair is the right tool to help you function safely at home—and your medical records clearly say so—Medicare may cover it.

Types of Wheelchairs Medicare May Cover

A) Manual Wheelchairs

Basic manual chairs are standard, self‑propelled or companion‑pushed chairs. They’re typically approved when you have enough arm strength or a caregiver to push, and when lighter options aren’t medically necessary.

Lightweight or ultra‑lightweight models may be approved if documentation shows you need a lighter frame to propel the chair effectively or to navigate your home’s layout (for example, tighter spaces or frequent transfers). Your clinician must explain why a standard chair isn’t sufficient.

Best for: People with adequate upper‑body strength or reliable caregiver assistance, and homes with accessible pathways and doorways.

B) Power Mobility

Power‑operated vehicles (POVs or scooters) are three‑ or four‑wheeled devices steered with a tiller. They’re considered when you can safely transfer on and off, sit upright without significant trunk support, and steer with both hands. Scooters may not be appropriate if you need more postural support.

Power wheelchairs use a joystick or alternative controls and can be configured for greater seating and positioning needs. Because they’re more complex and expensive, they require more detailed documentation, and many models require prior authorization. Your records must show you cannot use a manual wheelchair or scooter safely and effectively inside your home.

Best for: People who cannot propel a manual chair and cannot safely operate a scooter, or who need specialized seating, pressure relief, or alternative controls.

C) Accessories (Limited Coverage)

Medicare may cover certain accessories when medically necessary and documented, including seat cushions, elevating leg rests, anti‑tippers, and some custom seating components. Coverage is not automatic—your clinician must justify each item.

Medicare Eligibility Requirements (Key Section)

To qualify for a Medicare‑covered wheelchair, you’ll generally need:

Medicare Part B enrollment: DME is covered under Part B when your supplier and clinician are enrolled in Medicare.
Face‑to‑face examination: A visit with a Medicare‑enrolled doctor or qualified practitioner to evaluate your mobility limitations and home needs. This ensures the wheelchair is clinically appropriate.
Written order (prescription) and medical records: The order must specify the wheelchair type and any accessories. Progress notes should describe your condition, why lesser aids won’t work, and your ability to use the device safely.
In‑home need: Documentation must show the wheelchair is needed to perform daily activities inside the home, not primarily outdoors.
Inadequacy of other aids: Records must explain why a cane, walker, or manual chair (as applicable) isn’t sufficient before moving up to a scooter or power wheelchair.

Why these rules exist: Medicare aims to ensure the right level of equipment for your functional needs and to prevent paying for devices that don’t improve in‑home safety or function.

Common denial reasons: missing face‑to‑face exam, insufficient notes about in‑home activities, lack of trial/consideration of lower‑level aids, or using a supplier that isn’t Medicare‑approved.

Step‑by‑Step: How to Qualify

1) Schedule a doctor’s appointment: Ask for a mobility evaluation focused on daily tasks at home (bathing, toileting, meal prep, moving room to room).
2) Describe your limitations clearly: Share specific examples (e.g., “I can’t get to the bathroom safely with a walker due to fatigue”). Bring a list of falls, pain levels, distances you can walk, and caregiver support.
3) Complete required evaluation: Your clinician documents strength, balance, endurance, transfers, cognition, and home layout (door widths, thresholds, flooring, ramps). For power mobility, they may refer you to a physical or occupational therapist evaluation.
4) Obtain a written order: The prescription should specify manual vs power, accessories, and any positioning needs. Ensure your provider is Medicare‑enrolled.
5) Choose a Medicare‑approved DME supplier: Confirm they accept Medicare assignment to limit your costs and that they can handle prior authorization if required.
6) Supplier submits paperwork: The supplier sends the order, clinical notes, and any required forms/photos to Medicare or your plan.
7) Review and approval: Original Medicare may approve promptly or request additional information. For certain power wheelchairs, prior authorization is common. Typical timelines range from a few days to several weeks depending on documentation completeness and device complexity.

Tip: Keep copies of all notes, orders, and supplier communications. Respond quickly to any requests for additional information.

Costs, Copays & What Medicare Pays

Original Medicare (Part B): After you meet the Part B deductible, Medicare generally pays 80% of the approved amount for covered DME. You typically pay 20% coinsurance.
Renting vs purchasing: Many wheelchairs are initially rented; some may convert to purchase after a period. Renting can simplify repairs and maintenance through the supplier.
Medigap (Supplement) plans: May cover some or all of the 20% coinsurance, depending on your plan.
Medicare Advantage (Part C): You’ll owe plan‑specific copays/coinsurance and follow plan rules (e.g., prior authorization, network suppliers). Out‑of‑pocket limits may apply.

Common Reasons Wheelchair Claims Are Denied

Incomplete documentation: Notes don’t clearly state why lesser aids fail or how the wheelchair is used inside the home.
Missed face‑to‑face exam requirements: Timing or content doesn’t meet Medicare standards.
Non‑Medicare supplier: Ordering from a supplier who isn’t Medicare‑enrolled or won’t accept assignment.
Requesting a power device when manual qualifies: Records don’t justify the higher‑level device.
Home environment not documented: No assessment of door widths, surfaces, or safe operation at home.

Reduce denial risk: Work with your clinician on detailed notes, verify supplier enrollment, and ensure the order and evaluation specifically address in‑home activities and safety.

Medicare Advantage vs Original Medicare

Original Medicare: Follows national coverage rules and allows you to choose any Medicare‑enrolled supplier that accepts assignment. Prior authorization applies to certain power devices.

Medicare Advantage: Must cover at least what Original Medicare covers, but plans can require prior authorization, use network suppliers, and apply different copays. Always check your plan’s DME rules before ordering.

Quality, Safety & Risk Reduction

Get the right fit: Proper seat width/depth, cushions, and positioning reduce skin breakdown and falls.
Use approved suppliers: They provide setup, education, warranty support, and repairs.
Ask about service: How are repairs handled? Is a loaner available during servicing?
Avoid misleading offers: Be wary of “free wheelchair” ads. If it sounds too good to be true, it usually is. Always confirm Medicare coverage first.

Use‑Case Scenarios

Seniors with arthritis or balance issues: If a cane or walker no longer provides enough stability, a manual wheelchair may be approved to improve safe in‑home mobility.
Stroke recovery: When one side is weak and propelling a manual chair is unrealistic, a power wheelchair could be justified if you can safely operate the controls at home.
Progressive conditions (e.g., MS, ALS, Parkinson’s): Documentation should describe declining strength/endurance and the need for power mobility and seating supports to prevent falls and pressure injuries.
Temporary needs (post‑surgery or fracture): A rental manual wheelchair may be appropriate during recovery if it enables safe movement at home.
Caregivers managing paperwork: Keep a folder with the face‑to‑face note, prescription, supplier info, and any prior authorization approvals to streamline follow‑ups.

Mistakes & Pitfalls to Avoid

Ordering before the doctor visit: Medicare requires a face‑to‑face evaluation first.
Paying out of pocket too soon: Don’t buy equipment before coverage is confirmed; you may not be reimbursed.
Using non‑approved suppliers: Verify Medicare enrollment and assignment acceptance.
Not appealing a denial: You have the right to appeal; often, adding missing documentation can reverse a decision.
Assuming approval is automatic: Higher‑level devices (e.g., power chairs) often require extensive documentation and sometimes prior authorization.

Decision Support Tools

Medicare Wheelchair Qualification Checklist

I’m enrolled in Medicare Part B.
I completed a face‑to‑face mobility evaluation with a Medicare‑enrolled clinician.
I have a written order specifying the wheelchair type and any accessories.
My medical records explain why a cane/walker/manual chair (as applicable) isn’t sufficient.
My need is primarily for in‑home activities of daily living.
I selected a Medicare‑approved supplier that accepts assignment.
Prior authorization was submitted (if required) and I kept copies of all paperwork.

Do I Meet Medicare’s Criteria? (Self‑Assessment)

Can I safely perform daily activities at home without a wheelchair? If not, which tasks are affected?
Have I tried or considered lower‑level aids? Why aren’t they enough?
Can I safely operate the recommended device, or do I have a caregiver who can assist?
Is my home accessible (door widths, flooring, thresholds) for the recommended device?

Next Steps Summary

Start with your doctor: Request a mobility evaluation focused on in‑home function.
Document home needs: Note specific rooms/tasks you can’t reach or do safely.
Use Medicare‑approved suppliers: Confirm enrollment and assignment acceptance.
Ask questions before ordering: Coverage, prior authorization, rental vs purchase, and service.