Medicare covers a new wheelchair once every five years, with some exceptions for damage or major changes in your condition

Medicare Part B pays for a wheelchair (called a "mobility device" in Medicare language) once in a five-year period. If your wheelchair is damaged beyond repair or your medical condition changes significantly — such as after a stroke or amputation — you may be able to get a replacement sooner. The five-year clock restarts from the date Medicare paid for your last wheelchair, not from when you received it.

The wheelchair must be medically necessary, meaning your doctor has documented that you cannot walk safely without one. Medicare does not cover wheelchairs for convenience or comfort alone. You will also need a prescription from your doctor and an order from a supplier enrolled in Medicare.

Key Takeaways

  • Medicare covers one wheelchair per five-year period under Part B, starting from the date of the previous wheelchair payment.
  • Your doctor must prescribe the wheelchair and document that it is medically necessary for your mobility or safety.
  • You pay 20 percent of the approved amount after you meet your Part B deductible; Medicare pays the remaining 80 percent.
  • If your wheelchair is damaged or your condition changes significantly before five years have passed, contact your doctor to request an exception.
  • A Medigap or Medicare Advantage plan may cover some or all of your 20 percent cost-sharing, depending on your plan.

What counts as a wheelchair under Medicare

Medicare covers manual wheelchairs, power wheelchairs, and scooters (called "motorized three-wheeled vehicles" in Medicare rules). The device must be ordered through a Medicare-enrolled supplier, not purchased directly from a retail store. Even if you buy a wheelchair out of pocket, it does not reset your five-year period — Medicare tracks the date of payment, not purchase.

Medicare distinguishes between standard wheelchairs and custom or specialized models. A standard manual wheelchair is covered at a lower approved amount. A power wheelchair or one with custom features (such as a tilt mechanism or specialized seating) is covered at a higher approved amount. Your doctor's prescription should specify which type is medically necessary for your condition.

How the five-year rule works in practice

The five-year period is measured from the date Medicare paid the supplier for your last wheelchair, not the date you received it or the date your doctor wrote the prescription. If Medicare paid on January 15, 2020, your next wheelchair would be covered on January 15, 2025 or later. If you need a replacement on January 10, 2025, you would not yet be may be able to access under the standard rule.

The five-year clock applies to each type of device separately in some cases. If Medicare paid for a manual wheelchair in 2020, you might be able to get a power wheelchair before 2025 if your condition has changed and your doctor prescribes it as medically necessary. However, you cannot get two power wheelchairs within five years. Check with your supplier or call Medicare at 1-800-MEDICARE to confirm how the rule applies to your specific situation.

Exceptions to the five-year rule

Medicare may cover a replacement wheelchair before five years have passed if your current wheelchair is damaged beyond repair due to an accident or normal wear, or if your medical condition has changed significantly. A significant change might include a new diagnosis, a stroke, an amputation, or a major loss of function. Your doctor must document the change and explain why your previous wheelchair no longer meets your medical needs.

To request an exception, ask your doctor to write a new prescription and include a statement explaining why the replacement is medically necessary before the five-year mark. Submit this to a Medicare-enrolled supplier along with documentation of the damage (if applicable) or the change in condition. The supplier will submit the request to Medicare for review. Medicare may approve or deny the request; there is no may provide an exception will be granted.

What you pay for a wheelchair

You pay 20 percent of Medicare's approved amount for the wheelchair after you have met your Part B deductible for the year. Medicare pays the remaining 80 percent. The approved amount varies by region and by the type of wheelchair. A standard manual wheelchair might have an approved amount of $800 to $1,200, while a power wheelchair could be $4,000 to $6,000 or more, depending on features and your location.

If you have a Medigap policy (supplemental insurance), it may cover some or all of your 20 percent cost-sharing. If you have a Medicare Advantage plan, your out-of-pocket cost depends on your plan's rules — some plans cover wheelchairs with little or no cost to you, while others charge a copay or coinsurance. Check your plan documents or call your plan's customer service to learn what you will owe.

How to order a wheelchair through Medicare

Start by seeing your doctor and explaining that you need a wheelchair. Your doctor will examine you and, if a wheelchair is medically necessary, will write a prescription specifying the type (manual, power, or scooter) and any special features. The prescription does not need to be in any special format, but it should be clear and include your diagnosis and why the wheelchair is necessary.

Next, contact a Medicare-enrolled durable medical equipment (DME) supplier in your area. You can find suppliers by visiting Medicare.gov and using the supplier search tool, or by calling 1-800-MEDICARE. Give the supplier your prescription and Medicare information. The supplier will verify that you meet Medicare's coverage rules, submit the order to Medicare for approval, and arrange delivery once approved. The entire process typically takes two to four weeks.

What to ask your doctor

Ask your doctor whether a wheelchair is medically necessary for your safety and mobility. If you already have a wheelchair and it is not working well, ask whether your condition has changed enough to justify a replacement before five years have passed. Ask your doctor to document the reason clearly in your medical record, as this documentation will be reviewed by Medicare.

If you are unsure whether you are within your five-year window, ask your doctor's office to check your Medicare records or contact your previous supplier to find out when Medicare last paid for a wheelchair. Your doctor's office can also help you understand whether a power wheelchair or a manual wheelchair is the right choice for your situation.

Frequently Asked Questions

Can I get a wheelchair before five years if mine is broken?

Yes, if your wheelchair is damaged beyond repair, Medicare may cover a replacement before five years have passed. You will need your doctor to write a new prescription and the supplier to document the damage. Medicare will review the request, but approval is not may provide.

Does Medicare cover wheelchair repairs or maintenance?

Medicare covers repairs and routine maintenance of your wheelchair at no cost to you if the wheelchair was paid for by Medicare. The supplier who provided the wheelchair typically handles repairs. If repairs are not possible, that is when you may be able to request a replacement.

What if I have a Medicare Advantage plan instead of Original Medicare?

Medicare Advantage plans must cover wheelchairs under the same five-year rule as Original Medicare, but your out-of-pocket cost may be different. Some plans cover wheelchairs with no copay, while others charge a copay or require you to use a specific supplier. Check your plan documents or call your plan to learn your costs.

Can I buy a wheelchair on my own and have Medicare reimburse me?

No. Medicare only pays when you order through a Medicare-enrolled DME supplier. If you purchase a wheelchair on your own, Medicare will not reimburse you, and it will not count toward your five-year limit.

What happens if I move to a different state?

Your five-year period follows you — it does not reset when you move. Find a Medicare-enrolled supplier in your new state and provide them with information about your previous wheelchair. They can verify your five-year status with Medicare before placing a new order.