You might think that if you’re 65 or older and need a wheelchair or electric scooter to get around, Medicare will automatically cover it. But, as in many areas of Medicare, things are not that simple.
Whether Medicare will pay for the cost of a mobility device such as a manual wheelchair, electric wheelchair, or electric scooter depends on whether you meet all the requirements.
“It’s not the easiest thing in the world,” says Diane Omdahl, author of Medicare for you and co-founder of the Medicare consulting firm, 65 Incorporated.
Manual wheelchairs, electric wheelchairs and scooters
To clear up any confusion about terminology: a manual wheelchair is one that is pushed by you or your assistant; an electric wheelchair (also called a power wheelchair or power wheelchair) is for people who lack the motor function or cardiovascular strength to use a manual wheelchair, and an electric or electric scooter helps users who do not they can use a manual wheelchair and cannot use canes or walkers.
Even if you qualify for Medicare reimbursement for a mobility device, you will owe 20% of the approved amount — your coinsurance — after you pay your Part B deductible, which is $240 in 2024.
Medicare Reimbursement Rules
The first rule for Medicare coverage of a wheelchair or scooter is that you must have a medical need for it in your home.
“That doesn’t mean you have to use it exclusively in your home, but that you need it,” says Casey Schwarz, senior advisor for education and federal policy at the Medicare Rights Center.
Medicare will not cover your wheelchair or scooter if you only want the device for convenience or when you are traveling. Even traditional Medicare will not pay for a home wheelchair ramp.
The second rule for reimbursement is what Medicare calls “limited mobility.”
This means having all of these:
- A health condition that causes significant difficulty moving around the house
- Inability to perform activities of daily living such as washing, dressing, or using the bathroom with the aid of a cane, crutch, or walker
- The ability to safely operate a wheelchair or scooter or someone always available to help you do so
Pass these tests and you will need a face-to-face exam by a doctor (who must participate in Medicare). Your doctor will then submit a Certificate of Need to Medicare stating that you have medical necessity and that they are treating you for the condition.
You may need prior authorization from Medicare to get reimbursed for a power wheelchair. This is true whether you are enrolled in a traditional Medicare plan or a health insurer’s Medicare Advantage plan. The Medicare site has a list of more than 40 power wheelchairs that require prior authorization.
“The provider and your healthcare provider will submit prior authorization,” Schwarz says. “If it is denied or you need to provide more information, you can submit a new request.
Buy or rent
You can buy or rent wheelchairs and scooters. Manual wheelchairs tend to cost between $1,000 and $2,000; electric wheelchairs can cost well over $10,000. Electric scooters cost from $600 to $4,000. Rents often range from $100 to $400 per month.
Typically, if you rent a mobility device, ownership will transfer to you after 13 months.
Medicare will not replace a wheelchair or scooter you recently purchased or started renting because you are dissatisfied with it.
“If you have a chair that doesn’t fit and you’re not comfortable with, but Medicare has already paid for it, they won’t give you another one for five years,” says Paul Lane, the accessibility specialist and manager of technology access for the United Spinal Association’s Tech Access Initiative.
Expanded Medicare Wheelchair Benefit
Last year, Medicare expanded its coverage for power wheelchairs to include power seat elevation. This feature helps users reach countertops and cabinets more easily.
“This historic decision by Medicare to cover seat elevation is an important milestone that will improve the quality of life for so many who rely on this technology,” says Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services ( CMS) in a statement.
You will need an evaluation by a qualified medical professional to qualify for the seat lift benefit.
The Independence Through Enhancement of Medicare and Medicaid (ITEM) coalition of groups like the Medicare Rights Center and the United Spinal Association wants Medicare to also cover power standing features for wheelchairs.
“Standing wheelchairs can reduce bedsores and increase bowel and bladder function,” says Lane.
CMS said it plans to consider covering them in the future.
Where to find wheelchairs and scooters
To purchase or rent a wheelchair or scooter and be reimbursed by Medicare, you must go to a durable medical equipment supplier that accepts Medicare. You can find ones near you on Medicare.gov.
Don’t buy a wheelchair at a pharmacy or department store just because it’s cheap and you assume the store is Medicare certified. “If you go to a corner pharmacy in a remote area, I doubt they’re certified,” Omdahl says.
Pay attention to the nomenclature: a provider approved by Medicare but not accepting Assignment may cause you to pay more for a wheelchair or scooter than the amount approved by Medicare.
Medicare Advantage Rules
Private health insurers’ Medicare Advantage plans (the alternative to traditional Medicare) have their own networks of wheelchair and scooter providers, as well as their own mobility device coverage rules.
“I have found one Medicare Advantage insurer that will transfer ownership of a wheelchair to the user after 13 months, a second that will transfer certain items, and one that never transfers, regardless of how many co-payments are made,” Omdahl says.
Get an evaluation first
Before you buy or rent a wheelchair or scooter, your doctor or equipment supplier should visit your home to verify that you can actually use them there.
Your durable medical equipment supplier may send a certified assistive technology professional (ATP) to evaluate and determine the features of the chair or scooter you need and that Medicare will approve.
“They are quite experienced. They’ll say, “Medicare won’t pay for this.” Medicare won’t pay for this.’ They guide you along the way,” says Lane.
Narrow door problems
A home evaluation is crucial before purchasing a wheelchair as some models are too wide to fit through doorways.
“I had a chair five or six years ago and it was huge and difficult for me to fit into different doors in my house,” Lane says. “I would scrape a lot of walls.”
Omdahl remembers when she was a home health nurse helping a woman with a broken hip who had a wheelchair that wouldn’t fit through her bedroom door. “I moved the bed to the doorway and taught the woman how to get up and jump on the bed,” Omdahl says.
The United Spinal Association site contains user reviews of thousands of wheelchairs. You can search by model, manufacturer or type.