Does Medicare cover wheelchair rental costs?
Yes, but only when certain conditions are satisfied.
The short answer in terms of coverage : Medicare Part B covers wheelchair rentals when medically necessary for home use.
Breaking down this further: under Medicare, medically necessary refers to health care services or supplies that are needed for the diagnosis, direct care and treatment of your medical condition. A doctor’s certification or prescription is typically required to prove medical necessity. For Medicare to cover a wheelchair, it must be needed for home use. This means that the wheelchair is primarily used for mobility within your home and your have significant difficulty moving around without. Medicare will not cover wheelchairs needed only for outdoor or community use.
For example, a wheelchair is considered medically necessary when your doctors determines you have a health condition that significantly limits your mobility and you cannot perform daily activities (like bathing or dressing) in your residence without it – even with a cane or rollator, for instance.
How much is a wheelchair rental? You’ll pay 20% of costs after meeting your $257 deductible, and Medicare covers 80%. After 13 months of rental, the wheelchair becomes yours. So, as a real world example, if Medicare approves a $100 per month rental:
- Up front you will pay $257 Part B Deductible
- Months 1-13 you will pay $20 a month (20% of $100)
- Months 14+ you pay nothing
- Your total out of pocket cost is $517
Note that manual wheelchair rental can range from $60 to over $200 a month, based on features, while a power wheelchair can range from $300 to over $700 a month. Therefore, a manual chair rental approved by Medicare would cost between $413 and $775 per year, while a power chair would cost between $1,037 and $2,077 per year. These prices will also vary by region.
Understanding Medicare’s Wheelchair Coverage
Medicare Part B (medical insurance outside of the hospital) classifies wheelchairs as Durable Medical Equipment (DME), if they meet the criteria that they:
- are durable, and can withstand repeated use
- have a medical purpose, prescribed for repeated use
- are long lasting, expected to last 3 years or more
- are for home use – they are primary needed for mobility in your home
Types of Wheelchairs Covered
- Manual wheelchairs (standard and lightweight)
- Power wheelchairs (electric/motorized)
- Mobility scooters (when medically appropriate)
- Specialized wheelchairs (bariatric, reclining etc.)
Wheelchair accessories
There are many options and accessories for wheelchairs that you may consider.
- Arm rests – provide arm support, greater comfort and assist in transfers
- Batteries – for extended range, longer battery life and weight savings (a lead-acid battery typically makes up to 40% of a power wheelchairs total weight, vs lithium batteries, which can be 60-80% lighter and has a longer lifespan, but costs more)
- Chargers – higher-amp chargers can reduce charging time while modern “smart” chargers optimize charging speed and health by automatically adjusting current and voltage.
- Elevation Systems – raise and lower the seat height automatically to reach items and enable level transfers.
- Head Rests – provide neck support during prolonged sitting or transport.
- Larger Seats – for users needing extra space or support
- Leg Rests – for users who need to elevate or support their levels to prevent swelling
These items may be covered, if medically necessary. Further details can be found here.
Additional Covered Services
During rental, Medicare will also cover:
- Repairs and maintenance
- Loaner wheelchairs during repairs
- Delivery and setup
- Basic training on wheelchair use
Wheelchair Rental Eligibility Requirements
To qualify for a wheelchair rental, you need to meet all of these criteria:
- A Physician certifies medical necessity for home mobility
- You obtain a written prescription along with a detailed letter of medical necessity, an explanation of mobility limitations, along with reasons why other mobility aids won’t work
- The physician and supplier must be Medicare enrolled
Special Requirements for Power Wheelchairs
In addition, to qualify for a power wheelchair, you require:
- Prior authorization from Medicare
- In person evaluation with your doctor
- Mobility assessment documentation
- Proof that a manual wheelchair won’t meet your needs
What is NOT covered in a wheelchair rental
- Outdoor-only use: the wheelchair’s primary use should be for home mobility
- Convenience items or luxury features: non-medically necessary equipment
- Non-enrolled suppliers: Equipment from non-Medicare providers
Why Claims Are Commonly Denied
Approximately 14% of DME claims (including wheelchair rentals) are denied by Medicare carriers. More than half these are due to “same or similar” equipment issues (i.e. the patient already has a similar item within the same coverage period). Other reasons include:
- Insufficient medical documentation – lack of prescription, certificate of medical necessity or sufficient clinical notes
- Non-enrolled supplier
- Lack of home use justification
- Missing prior authorization (for power wheelchairs)
Frequently Asked Questions
Q: Does Medicare cover wheelchair rentals for use outside the home?
A: Coverage is primarily for mobility needs inside your home. If you only need a wheelchair for outdoor use, Medicare may not cover it
Q: Can I get a replacement wheelchair before five years?
A: Generally, Medicare covers one wheelchair every five years unless yours is lost, stolen, or damaged beyond repair
Q: What happens if my wheelchair needs repairs during the rental period?
A: Medicare covers repairs and may provide a loaner chair while yours is fixed
For further information regarding Medicare eligibility, click here