Medicare & Insurance Guide
A step-by-step guide explaining how Medicare covers power wheelchairs and other mobility equipment.
Understanding how insurance covers medical equipment can be confusing and overwhelming. We're here to make it simple, clear, and actionable.
Medicare Part B Covers DME
Medicare Part B (Medical Insurance) covers medically necessary Durable Medical Equipment (DME), including power wheelchairs, when prescribed by a physician for use in the patient's home.
The Face-to-Face Requirement
Before Medicare will cover a power wheelchair, the patient must have a face-to-face examination with their treating physician. The physician must document the medical necessity in writing.
Prior Authorization
CMS requires prior authorization for certain power wheelchairs (specifically Group 3 complex rehab chairs). The DME supplier submits this request along with the physician's documentation. You do not need to manage this process.
The 20% Cost Share
After meeting the annual Part B deductible, you are responsible for 20% of the Medicare-approved amount. Medicare pays the remaining 80% directly to the supplier.
Medicaid and Secondary Insurance
Many patients have both Medicare and Medicaid (called "dual eligibles") or a Medicare Supplement (Medigap) policy. In many cases, the secondary insurance covers the 20% patient cost share, resulting in little to no out-of-pocket cost for the patient.
What to Bring to Your First Appointment
To ensure a smooth process, please have the following ready for your evaluation:
- Your Medicare card
- Any secondary insurance cards
- A list of current medications
- Prior medical records related to your mobility