Who is Eligible?
Medicare recipients who meet all of the following criteria:
- Since this is a benefit under Medicare Part B, you must have Medicare Part B coverage.
- You must have a health condition that limits your mobility inside your home.
- You are unable to do daily living activities (such as bathing, dressing, using the restroom, etc.), even with use of a cane, crutch, or walker.
- You are able to safely operate and get on and off the equipment or have someone that is always available to assist you to use the device safely.
Who is Not Eligible?
You are not eligible to receive the equipment if:
- You are able to safely use a cane, crutch, or walker.
- You are only seeking the equipment for use outside of the home.
- You are only seeking the equipment for use in leisure or recreational activities.
What Type of Equipment is Right for Me?
Manual Wheelchair:
- If you cannot use a cane, crutch or walker safely for mobility inside your home, and
- You can safely operate a manual wheelchair.
Rolling Chair / Geri-chair:
- You may qualify for a rolling chair if you need more support than a wheelchair can provide.
Power-Operated Vehicle / Scooter:
- If you cannot use a cane, crutch, or walker safely for mobility inside your home, and
- You cannot safely operate a manual wheelchair.
Power Wheelchair:
- If you cannot use a cane, crutch, or walker safely for mobility inside your home;
- You cannot safely operate a manual wheelchair; and
- You are not strong enough to sit up or work scooter controls safely.
How Do I Obtain the Equipment?
Before you get a power wheelchair or scooter, you must take the following steps:
Step 1: Meet with your Doctor
- You must have a face-to-face examination by a doctor.
- The doctor will evaluate your strength, balance, and vision to determine if you can safely operate the equipment.
- The doctor must submit a written order (“Certificate of Necessity”) telling Medicare why you need the device and stating you can operate it safely.
Step 2: Choose the Equipment
- Immediately after the face-to-face examination, choose the equipment and submit the paperwork to the supplier. If you fail to submit the paperwork within 45 days, you will have to start the process over.
- You may need to get the equipment from a specific supplier that has been approved by Medicare. For more information, contact Medicare by phone or visit their website.
Additional Information
How Much Will I Pay?
Medicare will pay 80% of the approved amount, after you have paid the Part B deductible. You will be responsible for paying the remaining 20% of the Medicare approved amount.
Home Evaluations
It is very important to make sure the scooter or wheelchair purchased can adequately access and maneuver within your home. A home evaluation can be conducted by the supplier to make sure the product purchased is best suited for use within your home.
How to Appeal Medicare’s Decision
If Medicare fails to pay or pays less than you believe you are entitled to, you may file an appeal. Review the Medicare Summary Notice (MSN) provided to you and follow the instructions on the back to file the appeal. You must file within 120 days of the date you receive the MSN.
Other Resources
Medicare: 1-800-MEDICARE (1-800-633-4227)
TTY/TDD: 1-800-486-2048
Medicare Website
