Medicare Part B, also known as Medical Insurance, provides coverage for power-operated vehicles (scooters), walkers, and wheelchairs classified as durable medical equipment (DME). Medicare assists with DME coverage under the following conditions:
- Your treating doctor submits a written order indicating your medical necessity for a wheelchair or scooter for home use.
- You experience limited mobility and meet these criteria:
- You have a health condition significantly impeding your ability to move around within your home.
- Daily activities (e.g., bathing, dressing, transitioning from a bed or chair, or using the bathroom) are challenging for you, even with assistance from a cane, crutch, or walker.
- You can safely operate and embark on or disembark from the wheelchair or scooter, or you have someone available to assist you in safely using the device.
- The doctor treating your condition necessitating a wheelchair or scooter, as well as the supplier, both accept Medicare.
- Your doctor or supplier has conducted a home visit to confirm that you can effectively use the equipment within your residence (e.g., it can fit through your home’s doorways, is unobstructed by floor surfaces or obstacles).
You are responsible for covering 20% of the Medicare-approved amount after satisfying your annual Part B deductible. Medicare covers the remaining 80%.
If you are enrolled in a Medicare Advantage Plan, contact your plan to inquire about costs and approved DME suppliers.
Types of Equipment
- Manual Wheelchair: If you cannot safely use a cane or walker but possess adequate upper body strength (or have assistance available), you may qualify for a manual wheelchair. In some cases, you may need to rent a manual wheelchair initially, even if your intention is to eventually purchase one.
- Power-Operated Vehicle/Scooter: If you are unable to use a cane or walker or lack the ability to operate a manual wheelchair, you may be eligible for a power-operated scooter. To qualify, you must have the capacity to enter and exit it safely and possess the strength to sit upright and manage its controls. Note: If you do not require a scooter for long-term use, renting the equipment may be an option. Discuss this possibility with your supplier.
- Power Wheelchair: If you cannot effectively use a manual wheelchair within your home or do not meet the criteria for a power-operated scooter, you may meet the requirements for a power wheelchair. Note: Before receiving either a power wheelchair or scooter, you must undergo a face-to-face examination with your doctor. Your doctor will assess your needs and help determine if you can safely operate the device. Subsequently, your doctor will issue a written order to Medicare explaining why you require the device and that you are capable of using it.
Prior Authorization for Specific Equipment
For certain types of equipment, you may need “prior authorization.” In such cases, your durable medical equipment (DME) supplier will be required to:
- Request “prior authorization” for specific power wheelchairs (as listed on pages 3–5).
- Submit the “prior authorization” documents to Medicare, along with the equipment request.
You can initiate the request yourself if you obtain the necessary documents from your doctor and DME supplier. Medicare will review the information to ensure your eligibility and compliance with all item requirements. This program will not alter your Medicare coverage or benefits, and you should not encounter delays in obtaining the necessary items.