Medicare covers motorized wheelchairs, but only if a doctor prescribes one for medical reasons and you meet specific equipment rules

Medicare Part B covers a motorized wheelchair (called a power-operated vehicle or POV in Medicare language) the same way it covers other durable medical equipment — you need a doctor's written order, the wheelchair must meet Medicare's equipment standards, and you must use a Medicare-approved supplier. Medicare typically pays 80 percent of the approved amount after you have met your Part B deductible; you pay the remaining 20 percent.

The catch is that Medicare will not pay for a motorized wheelchair just because you want one or because walking is hard. A doctor must document that you cannot walk safely indoors even with a cane or walker, or that a condition makes walking unsafe. The wheelchair also cannot be a luxury model or one with features beyond what Medicare considers medically necessary.

Key Takeaways

  • Your doctor must write an order stating that you cannot walk safely indoors and that a motorized wheelchair is medically necessary for your condition.
  • Medicare pays 80 percent of the approved amount after your Part B deductible is met; you pay 20 percent out of pocket.
  • You must buy from a Medicare-approved durable medical equipment supplier, not from a retail store or online retailer.
  • Medicare requires a face-to-face evaluation by your doctor within six months before the order is written.
  • The motorized wheelchair must be a standard model; Medicare does not cover add-ons like seat lifts, standing features, or all-terrain wheels.

What your doctor needs to document

Medicare requires your doctor to state in writing that you cannot walk safely indoors for distances of 150 feet or more, even with a walker or cane. The order must also say that you have a medical condition that makes walking unsafe — examples include severe arthritis, Parkinson's disease, multiple sclerosis, spinal cord injury, or severe heart or lung disease. A note saying "patient wants a wheelchair" or "patient is elderly" is not enough.

Your doctor must have seen you in person within six months before writing the order. A phone call or a visit to a nurse does not count. If your last visit was longer than six months ago, you will need a new appointment before your doctor can write the prescription.

How to find a Medicare-approved supplier

You cannot buy a motorized wheelchair from a regular medical supply store, a big-box retailer, or an online seller and expect Medicare to pay. You must use a supplier enrolled in Medicare. The easiest way to find one is to call Medicare at 1-800-MEDICARE and ask for suppliers in your area, or search the Medicare Supplier Directory online at dmepos.cms.gov.

When you contact a supplier, tell them you have a doctor's order for a motorized wheelchair and ask what the Medicare-approved amount is for the model you need. The supplier will handle the paperwork to send to Medicare for review. Some suppliers will let you try a wheelchair before Medicare approves it; others will not. Ask about this upfront.

The Medicare review process and timeline

Once the supplier sends your doctor's order and medical records to Medicare, Medicare reviews whether the order meets its rules. This review usually takes 10 to 14 business days. Medicare may ask your doctor for more information if the documentation is unclear.

If Medicare approves the order, the supplier can deliver the wheelchair. You will receive a notice from Medicare telling you what it will pay and what you owe. If Medicare denies the order, you have the right to appeal. Your doctor and the supplier can help you file an appeal if you disagree with the decision.

What Medicare considers medically necessary

Medicare covers a standard motorized wheelchair with basic features: a seat, backrest, armrests, footrest, and a joystick or other control device. The wheelchair must be appropriate for indoor use and must not have features that go beyond medical need.

Medicare does not cover add-ons such as seat lifts, standing frames, all-terrain wheels, suspension systems, or custom upholstery. If you want these features, you can pay for them out of pocket after Medicare approves the base wheelchair. Some suppliers can install them after delivery.

Your out-of-pocket costs

After Medicare approves your motorized wheelchair, you pay 20 percent of the Medicare-approved amount. The approved amount varies by region and supplier, but typically ranges from $4,000 to $6,000 for a standard motorized wheelchair. This means your 20 percent share could be $800 to $1,200.

You also pay your Part B deductible if you have not met it yet this year. For 2024, the Part B deductible is $240. Once you have paid the deductible, Medicare begins paying its 80 percent share. If you have a Medigap or Medicare Advantage plan, it may cover some or all of your 20 percent cost-sharing; check your plan documents or call your plan to ask.

What happens if Medicare denies your order

Medicare may deny a motorized wheelchair order if your doctor's documentation does not show that you cannot walk safely indoors, if the order does not include a recent face-to-face visit, or if Medicare decides the wheelchair is not medically necessary for your condition. A denial does not mean you cannot have a motorized wheelchair — it means Medicare will not pay for it.

You have the right to appeal a denial. Your doctor can provide additional medical records or a more detailed explanation of why the wheelchair is necessary. The supplier can also help you file an appeal. The appeal process takes additional time, usually 30 to 60 days, but it is worth doing if you believe Medicare made a mistake.

Frequently Asked Questions

Can I buy a motorized wheelchair myself and ask Medicare to reimburse me?

No. Medicare will only pay if you use a Medicare-approved supplier. If you buy a wheelchair on your own, Medicare will not pay you back, even if a doctor prescribed it. Always contact a Medicare-approved supplier first and let them handle the Medicare paperwork.

What if my doctor says I need a motorized wheelchair but I have not seen them in six months?

You will need a new appointment. Medicare requires a face-to-face visit within six months before the order is written. Schedule an appointment with your doctor and bring up the wheelchair need at that visit. Your doctor can then write the order.

Does Medicare cover motorized wheelchairs for outdoor use?

Medicare covers motorized wheelchairs for indoor use. If you need a wheelchair that can handle outdoor terrain, you would need to pay out of pocket, as Medicare considers that beyond medical necessity for standard coverage.

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

Medicare does not reimburse for equipment you have already bought. You must work with a Medicare-approved supplier before you purchase. If you bought one before getting a Medicare order, you cannot go back and ask Medicare to pay.

How long does a motorized wheelchair last before Medicare will pay for a replacement?

Medicare typically covers a replacement motorized wheelchair every five years if your medical condition still requires it and your doctor writes a new order. You will need a new face-to-face visit and updated medical documentation for the replacement order.