Does Medicare Cover Electric Wheelchairs?

Medicare covers electric wheelchairs under Part B if a power wheelchair is determined to be medically necessary. Medicare coverage criteria for electric wheelchairs are different from other mobility devices, such as scooters and walkers.

Before browsing electric wheelchair options, it’s important to understand Medicare coverage requirements. Patients seeking coverage for an electric wheelchair will need a face-to-face exam and a written order (prescription). Additionally, the durable medical equipment (DME) provider must not deliver an electric wheelchair without a written prescription from a doctor. Otherwise, the device may be excluded from coverage.

Medicare coverage rules state electric wheelchairs, also called power wheelchairs, are covered only if an individual meets certain criteria. Furthermore, local coverage guidelines may affect how Medicare covers electric wheelchairs in certain areas. In general, Medicare may cover electric wheelchairs provided an individual:

• Cannot appropriately use an alternative power-operated vehicle
• Has the physical and mental ability to safely operate an electric wheelchair or has a caregiver who can’t safely operate a manual wheelchair
• Meets the required weight capacity limits for the specific chair model
• Has navigable space in their home for in-home use of the electric wheelchair
• Needs an electric wheelchair to manage activities of daily living
• Is willing to use an electric wheelchair at home

Electric wheelchairs are not automatically approved for coverage under Medicare. The DME provider may need to submit a prior authorization request to the health plan to confirm whether an individual qualifies. If approved, the request for an electric wheelchair is subject to the Part B deductible and 20% co-insurance if using a prescriber and DME provider who accept assignment for Medicare.

Provided coverage criteria are met, an electric wheelchair is covered at 80% under traditional Medicare Part B medical insurance. This means an individual will pay 20% of the Medicare-allowed amount. Factors that can affect the out-of-pocket cost of an electric wheelchair include:

• Whether an individual has other insurance coverage
• Whether coverage is through traditional Medicare or a Medicare Advantage plan
• Whether the prescriber and DME provider accept assignment for Medicare
• Whether the electric wheelchair is purchased or rented
• The total payable allowed amount for the particular model

Depending on the type of electric wheelchair ordered, the out-of-pocket cost can range from $200 to $1,000 without additional insurance coverage in place.

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