I need a new wheelchair, and I'm not sure if Medicare will cover it. What's the process for getting durable medical equipment?

Question

Norman Smith · Accepted Answer

Original Medicare pays for DME, unless noted anywhere within its policy Medicare Advantage plans do not.
You will have the 20% Co-pay responsibility, unless you have a Supplement plan that covers those charges.
That is an important feature in keeping your Original Medicare pays- it handles your DME, Medicare Advantage is typically handled Out-of-pocket by the insured.

Dana Dane · Answer

First, your doctor needs to prescribe this.  Next, please call your agent who can contact your insurance company to see if you qualify for a replacement.

Gary Henderson · Answer

Your doctor must provide you a letter AKA a prescription for any durable medical equipment. Contact your primary care physician

Vachik Chakhbazian · Answer

you'll need a prescription from your doctor stating the medical necessity and then find a Medicare-approved supplier.

Robert Simm · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/medicare-coverage-process-durable-medical-equipment#robert-simm

David Christian · Answer

Hello there.  A wheelchair falls under Medicare Part B as Durable Medical Equipment (DME).  The 
first thing you must do is get a prescription from your physician stating that you need the wheelchair and why?  

The process of getting the wheelchair will depend on what type of Medicare coverage you have. 

1. If you have Original Medicare only (Parts A & B only) or Original Medicare with a Medi-Gap plan, you will reach out to a Medicare Approved Supplier. 
2. If you have a Medicare Advantage Plan (MAPD), you put in the request through the Medical Group or Insurance Carrier and go through their contracted provider.

Betty McCarty · Answer

Prior authorization is usually required for Durable Medical Equipment. 

You might need to take the following steps: 

1.) Meet with your doctor to assess your physical condition.

2.) Check your Medicare plan. Medicare Part B covers 80% of the chair's costs after you meet your deductible.

3.) Evaluate your costs. Most manual and power wheelchairs are rented for the first 13 months, and you pay 20% coinsurance. 

4.) Schedule a doctor's appointment and explain why you need a wheelchair. 

5.) Obtain a doctor's prescription for the chair and contact your local Social Security office for an application for Medicare Part B benefits.

Scott Klag · Answer

Depending on your Health Plan you will be given a list of approved Durable Medical Equipment providers that you can use. The copays range from $0 to 20% of the cost of the equipment.

Eric Stokley · Answer

Medicare part B will cover 80% of Medical durable equipment after you have met your part B deductible. The equipment must be deemed medically necessary by your doctor and prescribed by you doctor for use at home.

Answered by Eric Stokley on April 22, 2025

Agent Licensed in GA & MS

Answered by Eric Stokley Medicare Insurance Agent

I need a new wheelchair, and I'm not sure if Medicare will cover it. What's the process for getting durable medical equipment?

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I need a new wheelchair, and I'm not sure if Medicare will cover it. What's the process for getting durable medical equipment?

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