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About 5.5 million people in the U.S. - more than 2% of the nation's population - use wheelchairs. Individuals ages 65 and older are 4 times more likely to use a wheelchair than those who are younger.

Medicare, the federal health insurance program for those 65 and older, covers manual and power wheelchairs (and power scooters) for people who need these assistive devices for mobility. This population includes people younger than 65 who have disabilities that qualify them for Medicare. Here's what you need to know to get Medicare coverage for a wheelchair.

Will Medicare cover my wheelchair?

As long as you meet eligibility requirements, Medicare Part B or Medicare Advantage will cover your wheelchair. Your request for this durable medical equipment (DME) will depend on several factors, including:

• Type of wheelchair requested, such as a manual or power wheelchair or a power scooter

• Your need for the wheelchair based on your diagnosis

• Your need for the wheelchair at home

Medicare Part B requirements for wheelchair coverage

Medicare Part B is medical coverage for outpatient care, including DME such as wheelchairs. To be covered, your wheelchair must be prescribed for use in your home.

For a power wheelchair, you must have an in-person exam and a prescription from a healthcare professional. Part B covers power wheelchairs and power scooters only if they are medically necessary at home.

Your prescribing doctor and DME supplier must be enrolled in Medicare.

The face-to-face visit for a manual wheelchair should be no more than 6 months before your prescription is written. For a power wheelchair, your in-person appointment should be no more than 45 days before the prescription is written. Medicare will cover only one type of mobility aid for use at home.

Type of wheelchairs Medicare covers

Medicare covers a variety of wheelchairs. The three main types are:

• Manual wheelchairs

• Power wheelchairs

• Power scooters

Wheelchair accessories

Your wheelchair will come with a basic package that is appropriate for you. For instance, your chair may have a larger, nonstandard seat that fits you. If medically necessary, options and accessories may be covered. These include:

• Arm rests

• Batteries

• Chargers

• Elevation systems for power chairs

• Head rests

• Larger seats

• Leg rests

What diagnosis do I need to qualify for a wheelchair?

Many disabilities can affect mobility, but not all conditions make you eligible for a Medicare-covered wheelchair or power chair. You need to be diagnosed with an illness or injury that causes limited mobility.

In addition to limited mobility, you must meet all of these criteria:

• You have a condition that causes significant difficulty moving around at home.

• You're unable to perform daily activities, such as bathing, dressing, or using the bathroom even with a cane, a crutch, or a walker.

• You can safely get on and off a wheelchair, or you have someone to help you use the device.

• The healthcare professional treating you and the wheelchair supplier both accept Medicare.

• The medical professional or supplier has visited your home to verify that you can use a wheelchair or power scooter there.

How to get a wheelchair covered by Medicare

Here are some tips for getting Medicare to cover the wheelchair you need.

Meet with your doctor

Your Medicare-enrolled healthcare professional should meet with you in person to assess your physical condition. If a wheelchair is medically necessary, the professional will write a prescription that states you have a medical need for the mobility aid in your home and indicates the type of wheelchair.

Check your plan

Medicare Part B covers 80% of your chair's costs after you meet your deductible, which is $240 in 2024. And your supplier may need to get prior authorization for a power wheelchair or scooter to be covered. (These are the types of power wheelchairs that require prior authorization.) Similar advance approval may be needed if you have a Medicare Advantage plan.

Evaluate your costs

For the first 13 months, most manual and power wheelchairs are rented, and you pay 20% coinsurance. After that, you own the chair outright. You must use a Medicare-enrolled supplier who agrees to "accept assignment" for your wheelchair order. If a supplier doesn't participate in Medicare and can't accept assignment, you could be charged the entire cost out of pocket.

If you have Medicare Advantage, you can find a description of plan cost sharing by reviewing your evidence of coverage or contacting your plan about wheelchair benefits.

Will I have to pay anything out of pocket?

With Medicare Part B, you pay your deductible and then 20% of the remaining costs. With Medicare Advantage, benefits and out-of-pocket costs will depend on your plan.

How often can a Medicare enrollee get a wheelchair?

In general, once every 5 years. You may be able to get a replacement sooner if you have a special circumstance, such as loss, theft, or damage beyond repair in an accident or a natural disaster.

For rented wheelchairs that are less than 5 years old, Medicare Part B will cover repairs and maintenance up to the cost of a replacement. The supplier will also pick up rented equipment in need of repair. Medicare covers the cost of loaned equipment while your chair is being fixed.

What to do if your claim is denied

If Medicare denies your claim for wheelchair coverage, file an appeal. The appeals process is different for Medicare Part B and Medicare Advantage.

DME rental or loan programs

If you can't get your wheelchair covered by Medicare, you're waiting on prior authorization, or you have an ongoing appeal - and you need mobility assistance immediately - you may be able to find a free DME loan program near you.

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