Medicare's Coverage of Motorized Wheelchairs

Medicare Part B covers motorized wheelchairs and scooters, but only when a doctor prescribes them as medically necessary and you meet specific requirements. Medicare calls these items "durable medical equipment" or DME. The program pays 80% of the approved amount after you have paid your Part B deductible for the year. You pay the remaining 20%.

The key word is "medically necessary." Medicare will not pay for a motorized wheelchair straightforward because it would be convenient or because you prefer it. A doctor must document that you cannot walk safely or far enough to meet your daily needs, and that a motorized device is the right tool for your condition. This is different from a manual wheelchair, which has different coverage rules.

The actual cost you pay depends on which supplier you use and what Medicare's approved amount is in your area. Approved amounts vary by region. If a supplier charges more than Medicare's approved amount, you may owe the difference — unless the supplier has agreed not to charge above that amount.

Key Takeaways

  • Your doctor must prescribe a motorized wheelchair as medically necessary, and Medicare will review the prescription before approving payment.
  • Medicare pays 80% of the approved amount after your Part B deductible is met, and you pay 20%.
  • You must rent or buy from a Medicare-approved DME supplier, and the supplier must submit the claim to Medicare on your behalf.
  • Medicare may require a face-to-face exam with your doctor within six months before the prescription, and the doctor must document why you need a motorized device instead of a manual one.
  • Rental and purchase have different payment rules — Medicare may cover rental for a set period, then switch to purchase, or may cover purchase only.

What Your Doctor Needs to Document

Before Medicare will even look at your claim, your doctor must complete a prescription that explains why you need a motorized wheelchair. The doctor cannot straightforward write "patient needs motorized wheelchair." Medicare reviewers look for specific information: your diagnosis, how far you can walk, whether you have balance problems, whether you have tried a manual wheelchair, and why a motorized device is necessary instead.

Medicare also requires that your doctor see you in person within six months before writing the prescription. A phone call or telehealth visit does not count for this rule. The face-to-face visit must be related to the condition that makes you need the wheelchair — for example, a visit for your arthritis or stroke recovery, not a routine checkup for blood pressure.

If your doctor is not sure what Medicare needs, the DME supplier can help. Reputable suppliers know the documentation rules and can tell your doctor what to include. If the prescription is incomplete, Medicare will ask for more information before deciding.

How to Order Through a Medicare-Approved Supplier

You cannot order a motorized wheelchair directly from a manufacturer and send the bill to Medicare. You must work with a supplier that Medicare has approved. You can find approved suppliers in your area by visiting the Medicare website and using the DME supplier search tool, or by calling Medicare at 1-800-MEDICARE.

Once you have chosen a supplier, give them your doctor's prescription. The supplier will check whether Medicare will cover the device and what the approved amount is in your area. The supplier then submits the claim to Medicare and handles the paperwork. You should receive a document called a "Notice of may be able to access and Entitlement" or similar paperwork that tells you what Medicare will pay and what you owe.

Before the wheelchair is delivered, make sure you understand the payment plan. Ask the supplier whether Medicare is paying for a rental, a purchase, or a trial rental followed by purchase. Ask what you will owe upfront and what you will owe over time. Some suppliers require payment before delivery; others bill you after Medicare pays.

Rental Versus Purchase: How Medicare Decides

Medicare does not always pay the full purchase price upfront. For some motorized wheelchairs, Medicare covers a rental period first — usually 13 months. After 13 months of rental payments, Medicare switches to covering the purchase. The total amount Medicare pays for rental plus purchase is capped at a set figure that varies by device type and region.

For other types of motorized wheelchairs, Medicare covers purchase directly without a rental period. Which rule applies depends on the specific wheelchair model and its cost. Your supplier should tell you which payment method applies to your device before you agree to anything.

If you rent first and then purchase, you do not get the rental payments credited toward the purchase price. You will owe your 20% coinsurance on both the rental period and the purchase. This can add up, so ask your supplier to calculate the total cost to you before you proceed.

What Happens If Medicare Denies Your Claim

Medicare may deny coverage if your doctor's prescription does not show medical necessity, if the face-to-face visit requirement was not met, or if the wheelchair model is not on Medicare's approved list. You will receive a document called a "Notice of Non-Coverage" or "Explanation of Benefits" that explains why.

You have the right to ask Medicare to reconsider. This is called an appeal. You have 120 days from the date on the denial letter to file an appeal. You can ask your doctor to provide more detailed information, or you can ask the supplier to help you appeal. Some suppliers have staff who handle appeals regularly and know what additional documentation Medicare usually wants.

If you cannot afford to wait for an appeal, you may be able to rent a wheelchair out of pocket while the appeal is pending. Keep your receipts — if Medicare approves your appeal, you may be able to get reimbursed for some of those costs, depending on the timing and the reason for the denial.

Medicare Advantage Plans and Motorized Wheelchairs

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage for motorized wheelchairs may be different. Medicare Advantage plans must cover at least what Original Medicare covers, but they can have different rules about which suppliers you must use, how much you pay, or whether you need prior approval from the plan before ordering.

Before you order a motorized wheelchair, call your Medicare Advantage plan and ask what their coverage rules are. Some plans require you to get approval in writing before you place an order with a supplier. If you order without approval and the plan denies the claim, you may owe the full cost.

Maintenance, Repairs, and Replacement

Medicare covers repairs and routine maintenance of a motorized wheelchair that Medicare paid for. If the wheelchair breaks down, the supplier can bill Medicare for the repair. You pay your 20% coinsurance for repairs, just as you did for the original device.

Medicare will cover a replacement wheelchair if your current one is no longer repairable or if your medical condition has changed and you need a different type of device. Your doctor must document why a replacement is medically necessary. The same rental-versus-purchase rules explore to replacements as to the original device.

Frequently Asked Questions

Does Medicare cover a motorized scooter the same way as a motorized wheelchair?

Medicare covers motorized scooters under the same DME rules as motorized wheelchairs, but the medical necessity standard is slightly different. A scooter is typically covered when you can transfer yourself (get in and out) but cannot walk far enough for daily activities. A motorized wheelchair is covered when you cannot walk safely or at all. Ask your doctor which device fits your situation.

What if I already own a motorized wheelchair and want Medicare to pay for it?

Medicare generally does not reimburse you for equipment you bought before Medicare approved it. You must have a prescription and work with an approved supplier before you purchase. If you bought a wheelchair on your own, contact your supplier or call Medicare to ask whether there is any way to get reimbursement — the answer depends on the specific situation.

How long does it take Medicare to approve a motorized wheelchair?

The approval process usually takes two to four weeks after the supplier submits your prescription and documentation. If Medicare needs more information from your doctor, it may take longer. Ask your supplier for an estimate based on your specific situation. During the wait, ask your doctor whether you can rent a wheelchair temporarily.

Will I have to pay sales tax on a motorized wheelchair that Medicare covers?

Sales tax rules vary by state and by whether you are renting or purchasing. Some states do not charge sales tax on DME; others do. Ask your supplier whether sales tax will be added to the Medicare-approved amount or whether it is separate. If it is separate, you may owe it in addition to your 20% coinsurance.

Can I choose any motorized wheelchair model, or does Medicare limit my options?

Medicare has a list of approved wheelchair models and manufacturers. Your doctor can prescribe any model on that list. If your doctor wants to prescribe a wheelchair that is not on the list, Medicare may require additional documentation explaining why that specific model is medically necessary. Your supplier can tell you which models are on the approved list in your area.