Electric Wheelchairs

Will Medicare Cover Electric Wheelchairs?

Medicare will cover electric or power wheelchairs. However, you must be able to show you have an honest medical need for one and the primary use must be for moving around your home. In other words, it just can't be something that would be nice to have or primarily for use outside the home. However, you must follow the steps below to ensure that Medicare pays for the equipment.

Only your doctor can prescribe the equipment for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you.
The doctor must document the need in your medical record and give you a signed and dated order (prescription) for the equipment.

How Much Will An Electric Wheelchair Cost With Medicare?

After you have paid your annual deductible, you will pay 20 percent of Medicare-approved amounts for the power wheelchair purchase or rental and maintenance. Those costs may be higher if the supplier doesn't accept assignment. Motorized/power wheelchairs are in the Capped Rental category, which means you may choose to rent or purchase a motorized/power wheelchair. Once Medicare has made 10 monthly rental payments you will be given an opportunity to purchase the wheelchair. The supplier will send you a 'Purchase Option' letter in the ninth month of the rental. You will have 30 days to reply.

If you reply and want to buy the wheelchair:

Medicare will make three more payments and the chair is yours
You will be responsible for maintenance (Medicare will cover 80 percent of maintenance costs)

If you do not answer or choose to continue renting:

Medicare will make a total of 15 rental payments and the wheelchair is yours to use as long as you need it.
The supplier keeps ownership of the chair and is responsible for maintaining it
You will be charged a maintenance and service fee every 6 months. Medicare will pay 80 percent of the maintenance and service fee.

Part B Coverage and Power Wheelchairs

You must have Medicare part B coverage and your doctor must have assessed your needs, documented your need in your medical record and wrote you an order (prescription) for the equipment. The supplier must have the order on file before billing for the chair. In addition, the need for the wheelchair must meet the following criteria:

You cannot walk on your own, even with the support of other mobility equipment
You have weakness in your upper body caused by injury or illness and cannot use a manual wheelchair because of upper body weakness
You would have to spend most of your time in bed or in a chair when not in your wheelchair
You can safely get in and out of a power wheelchair. You must also be able to sit in the wheelchair and work the controls.
You must need the wheelchair to help you move about independently, not to prevent an injury from occurring where no injury or illness exists (even through it will help prevent injury as well).

Where Do I Get An Electric Wheelchair?

You will save money if you order your items from a Medicare approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your power wheelchair from any store that sells them. However, if the supplier from which you order your chair is not enrolled in Medicare, Medicare will not pay for the equipment.

Things you should think about before you choose a supplier:

There are two types of Medicare suppliers, participating suppliers and those who are enrolled but have chosen not to participate.
Participating suppliers must accept assignment, which means they agree to accept a set fee for the wheelchair and will not charge more than the Medicare allowed charge.
A Medicare approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the chair. In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple months to receive payment.
If you receive your Medicare coverage through a Medicare Advantage Plan (HMO or PPO), it is likely that the plan will have its own steps for the purchase. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers -- they cannot supply less. Depending on your plan, you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan's customer service and ask about your coverage before you order your chair.

Coverage Topics

Quick Site Navigation

Untitled Document

This website is a private website and is not associated, endorsed or authorized by the Social Security Administration, the Health Care Financing Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services nor do we claim to be. This site contains basic information about Medicare, services related to Medicare and services for people with Medicare. If you would like to find more information about the Government Medicare program please visit the Official US Government Site for People with Medicare located at www.medicare.gov.