Medicare covers electric wheelchairs, but only under specific conditions and through a defined process

Medicare Part B covers electric wheelchairs (called power wheelchairs or motorized scooters) when a doctor determines you need one for mobility inside your home. The device must be prescribed by your doctor, ordered through a Medicare-approved supplier, and meet Medicare's medical necessity standards. You typically pay 20% of the approved amount after you meet your Part B deductible; Medicare pays the remaining 80%.

The coverage is not automatic. Your doctor must document that a manual wheelchair would not meet your medical needs, and you must use the device primarily in your home. Medicare distinguishes between a power wheelchair (which you control with a joystick or other input device while seated) and a motorized scooter (which you stand or sit on and steer like a vehicle). Both can be covered, but the rules differ slightly.

Key Takeaways

  • Your doctor must prescribe the wheelchair and state in writing that you cannot use a manual chair due to your medical condition.
  • You must order through a Medicare-approved durable medical equipment (DME) supplier, not directly from a manufacturer or non-approved retailer.
  • Medicare covers the wheelchair itself, but not accessories like cup holders, oxygen tank holders, or custom cushions unless they are medically necessary.
  • You pay 20% of Medicare's approved amount after meeting your Part B deductible; the actual price of the chair may be higher, and you are responsible for the difference if the supplier charges more than Medicare allows.
  • The approval process typically takes two to four weeks from the time your doctor's order reaches the supplier.

How to start the process with your doctor

Begin by talking to your primary care doctor or the specialist treating your mobility condition. Explain that you are having difficulty moving around your home and ask whether a power wheelchair or scooter might help. Your doctor does not have to agree—they may recommend physical therapy, a manual wheelchair, or other options first. If they do think a power wheelchair is medically necessary, they will write a prescription that includes the reason you need it and the specific type (power wheelchair or scooter).

Your doctor's prescription must state that you have a medical condition that prevents you from using a manual wheelchair, that you will use the device primarily in your home, and that you are able to operate it safely. Medicare reviewers read these prescriptions carefully. A vague prescription like "patient needs wheelchair" will be sent back for more detail. A strong prescription explains your diagnosis, your mobility limitations, and why a manual chair would not work for you.

Finding and working with a Medicare-approved supplier

Once you have a prescription, you need to order from a Medicare-approved DME supplier. Not all medical equipment companies are approved by Medicare. You can search for suppliers in your area on the Medicare website's DME supplier directory, or call 1-800-MEDICARE and ask for a list of approved suppliers near you.

Contact at least two or three suppliers and ask for a quote. Tell them you have a doctor's prescription and ask what your out-of-pocket cost will be. The supplier will submit your prescription and medical information to Medicare for review. This is sometimes called a prior authorization or pre-approval. Medicare will decide whether the wheelchair meets its coverage rules. If approved, the supplier will contact you with your cost-share amount and arrange delivery and setup.

Do not pay the supplier upfront. Wait until Medicare has approved the order. If you pay before approval and Medicare denies the claim, you may not get your money back. The supplier should handle all communication with Medicare on your behalf.

What Medicare's approval process looks like

When the supplier sends your prescription to Medicare, a Medicare contractor (a private company that processes claims for Medicare in your region) reviews it. They check whether your doctor's notes support medical necessity, whether you meet the coverage rules, and whether the type of wheelchair you need is appropriate for your condition.

The review usually takes one to two weeks. If Medicare approves the order, the supplier will contact you. If Medicare denies it, the supplier will tell you why. Common reasons for denial include: the doctor's notes do not clearly explain why you cannot use a manual wheelchair, the prescription does not state that you will use the device in your home, or Medicare determines the device is not medically necessary for your condition.

If your order is denied, you have the right to ask for a reconsideration. Your doctor can submit additional medical records or a more detailed letter explaining why the wheelchair is necessary. This appeal process can take several weeks.

What you pay and what Medicare pays

Medicare sets an approved amount for power wheelchairs and scooters. This amount varies by region and by the specific features of the device. After you meet your Part B deductible for the year, Medicare pays 80% of the approved amount, and you pay 20%.

The actual price of the wheelchair may be higher than Medicare's approved amount. If the supplier charges more, you are responsible for the difference—this is called balance billing. Before you order, ask the supplier what the Medicare approved amount is and what your 20% cost-share will be. Also ask whether they will charge you more than the approved amount. Some suppliers charge only the approved amount; others charge more.

Repairs and maintenance are usually covered by Medicare if the wheelchair breaks down during normal use. Routine maintenance like cleaning or battery replacement may not be covered. Ask your supplier what is included in the warranty and what you will have to pay for out of pocket.

Coverage limits and what is not covered

Medicare covers one power wheelchair or scooter per five-year period. If your wheelchair breaks down beyond repair within that five years, you may be able to get a replacement, but you will need a new doctor's prescription and Medicare approval.

Medicare does not cover accessories unless they are medically necessary and prescribed by your doctor. A cup holder, oxygen tank holder, or custom seat cushion for comfort is not covered. However, a specialized cushion prescribed to prevent pressure sores, or a mounting system for medical equipment, may be covered if your doctor documents the medical need.

Motorized scooters have additional limits. Medicare covers them only if you can walk some distance (at least 150 feet) but cannot walk far enough to meet your daily needs. If you cannot walk at all, Medicare typically covers a power wheelchair instead. Your doctor's prescription must specify which device is appropriate for your situation.

If Medicare denies your claim

A denial does not mean you cannot get a wheelchair—it means Medicare determined it does not meet coverage rules based on the information provided. You have the right to appeal.

The first step is reconsideration. You or your doctor can ask Medicare to review the decision again and submit additional medical evidence. Write a letter explaining why you believe the wheelchair is medically necessary, and ask your doctor to send updated medical records or a more detailed letter. Send this to the Medicare contractor listed on your denial letter. Reconsideration usually takes two to four weeks.

If reconsideration is denied, you can request a hearing before an administrative law judge. This is a more formal process and takes longer, but it gives you a chance to present your case in detail. Your doctor can participate in the hearing. Contact the Medicare Appeals office listed on your reconsideration denial letter for instructions.

Frequently Asked Questions

Does Medicare cover scooters for outdoor use?

Medicare covers motorized scooters only for use inside your home or in your when ready residential area. If you need a scooter primarily for outdoor activities or travel, Medicare will not cover it. Your doctor's prescription must state that the device is for home use.

What if my doctor says I need a wheelchair but I have not tried a manual chair yet?

Medicare may require you to try a manual wheelchair first to show that it does not meet your needs. Your doctor can document this in your medical record. If a manual chair is not practical for your condition, your doctor can explain that in the prescription and Medicare may approve a power wheelchair without a trial period.

Can I buy a wheelchair online and have Medicare reimburse me?

No. You must order through a Medicare-approved DME supplier. If you buy a wheelchair on your own, Medicare will not pay for it. The supplier handles the Medicare approval process and billing.

How long does it take to get a wheelchair after Medicare approves it?

Once Medicare approves the order, delivery and setup usually take one to three weeks, depending on the supplier and whether the wheelchair needs customization. The supplier will give you a delivery date when they contact you with your cost-share amount.

What happens if my wheelchair breaks and I need a replacement before five years?

If the wheelchair is damaged beyond repair, you can request a replacement before the five-year period ends. Your doctor will need to write a new prescription, and Medicare will need to approve it. The supplier can help you submit the request. Wear and tear from normal use is usually covered under warranty by the manufacturer.