Medicare is the largest single supplier of medical care in the United States, providing care to citizens ages 65 and older. Medicare pays for hospitalization, medications and the care of most of the elderly population in the United States.

Eligibility

Medicare will pay for wheelchairs that are needed in your home but will not pay for wheelchairs that are used solely for comfort or leisure. In May 2005, according to USA Tech Guide, it was decided by Medicare that mobility was not a medical necessity, a regulation still in effect in 2009. If you are able to perform activities such as getting to the kitchen (even if it is difficult or requires a walker or crutches), dressing yourself or using the bathroom without a wheelchair, Medicare will not consider your case.

Certificate of Medical Necessity

Talk to you doctor about getting a Certificate of Medical Necessity. This will be the only way Medicare will accept your claim. On the form, the doctor will need to provide the dates of your disability, the type of disability and the medical need for a wheelchair, and he will need to sign and date it. Motorized or scooter wheelchairs can be ordered only by rheumatologists, neurologists or orthopedic surgeons. Your doctor will give you the completed Certificate of Medical Necessity to bring to the wheelchair dealer.

Taking Your Claim to the Dealer

The wheelchair dealer must cross-check everything from your doctor before sending your claim and Certificate of Medical Necessity to Medicare. If there are mistakes or the form is incomplete, the dealer will have to absorb the cost of the chair (manufacturing costs and taxes) and may be fined (the dealer cannot make you pay for it). To avoid problems, the dealer may send in a request, known as Advance Determination of Medicare Coverage, asking if Medicare will approve your claim before delivery of your wheelchair. However, Medicare can still deny your claim after approving your ADMC if it thinks your situation does not justify a wheelchair. Some dealers will ask that you pay for the chair upfront while you wait to be reimbursed directly from Medicare, while others elect to have their business reimbursed from Medicare. The dealer can charge up to 15 percent more than the Medicare quoted price, which you will be responsible for paying.

Renting a Wheelchair

If your condition warrants using a wheelchair only temporarily, Medicare will make 15 rental payments for your chair, providing your doctor has provided a Certificate of Medical Necessity. If your doctor has decided you should purchase the chair during your rental period because of a permanent disability, Medicare will pay for three more rental payments (up to 13), therefore your doctor must decide if you need to purchase a chair before your 10th payment. The supplier will send you a form after the 10th payment giving you an option to purchase your chair, in which case your doctor will have to send in a new Certificate of Medical Necessity so you do not have to absorb the remainder of the cost. You will be responsible for any portion that Medicare will not cover and in some cases, 20 percent of what it will cover. You will also be responsible for unassigned claims, as in a case where you visit a doctor who does not participate in Medicare. That means you must pay him upfront and wait for reimbursement from Medicare. You will be responsible for what Medicare will not cover if your doctor elects not to participate in Medicare. If you have dual coverage (supplementary insurance), Medicare will still pay for your chair, but you must pay the remainder of what both insurances will not cover.

Maintenance

You will be responsible for finding a company that can maintain your wheelchair and is Medicare approved. Medicare will pay for, or reimburse you for, 80 percent of maintenance costs every six months.