Medicare covers a new wheelchair or scooter once every five years, as long as your doctor says you need it for mobility inside your home.

Medicare Part B pays 80% of the cost after you meet your yearly deductible. You pay the remaining 20%. The five-year window resets from the date Medicare approved your last wheelchair, not from when you ordered it or received it.

If your wheelchair breaks and cannot be repaired, you may be able to get a replacement sooner — sometimes within months rather than years. The rules depend on whether the damage happened because of normal wear, misuse, or a defect in the equipment itself.

Key Takeaways

  • Medicare covers one wheelchair or scooter every five years if your doctor documents that you cannot walk or move safely without it.
  • You must use a Medicare-enrolled supplier and get a written order from your doctor before you order the equipment.
  • Medicare pays 80% of the approved amount after your Part B deductible; you pay 20%.
  • A replacement before five years may be covered if the wheelchair cannot be repaired due to defect or irreparable damage.
  • Manual wheelchairs, powered wheelchairs, and scooters each have their own five-year clock.

What Medicare considers medically necessary for a wheelchair

Your doctor must document that you cannot walk 150 feet without stopping to rest, or cannot walk at all. The documentation also needs to show that a wheelchair or scooter will let you move around inside your home safely — not just that mobility would be nice to have.

Medicare does not cover wheelchairs for outdoor use only, travel, or occasional trips. The equipment must be something you use regularly at home. If your doctor says you need it only for specific outings, Medicare will likely deny the claim.

Your doctor does not have to be a specialist. Your primary care doctor, a cardiologist, a rheumatologist, or any licensed physician can write the order. The order must be specific: it should name the type of wheelchair (manual, powered, or scooter) and any special features your condition requires, such as a seat lift or tilt function.

How the five-year rule works in practice

The five years starts from the date Medicare approved your last wheelchair claim, not the date you received it. If Medicare approved your wheelchair on January 15, 2020, you become may be able to access for a new one on January 15, 2025 — even if you did not receive the first wheelchair until February.

Each type of mobility device has its own five-year timer. If you received a manual wheelchair in 2020, you can get a powered wheelchair or scooter in 2021 because they are different items. However, you cannot get a second powered wheelchair until five years after the first powered wheelchair was approved.

If you need a replacement before five years are up, you will need to show that the current wheelchair cannot be fixed. A supplier or repair technician usually has to document the damage in writing and explain why repair is not possible.

Getting a wheelchair through Medicare step by step

Start by talking to your doctor about whether a wheelchair or scooter would help you move around your home safely. If your doctor agrees, ask them to write a detailed order that describes the type of equipment and any special features you need.

Next, find a Medicare-enrolled supplier in your area. You can search for suppliers on the Medicare website under "Durable Medical Equipment, Prosthetics, Orthotics, and Supplies" (DMEPOS). Call at least two or three suppliers to compare prices, since Medicare pays the same amount regardless of which supplier you choose, but your 20% out-of-pocket cost may vary.

Give your supplier the written order from your doctor. The supplier will submit the claim to Medicare on your behalf. Medicare will review the order and your medical records to decide whether to approve it. This review usually takes one to two weeks.

Once Medicare approves the claim, you will receive a notice showing the approved amount, your deductible status, and what you owe. You can then order the wheelchair from your supplier. Delivery usually takes two to four weeks after approval.

What you pay out of pocket

You pay 20% of the Medicare-approved amount for the wheelchair or scooter. The approved amount varies by type and features — a basic manual wheelchair costs less than a powered wheelchair with special seating.

You also pay your Part B deductible if you have not met it yet this year. In 2024, the Part B deductible is $240, though this amount changes each year. Once you meet your deductible, you pay only the 20% coinsurance for the wheelchair.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower. Medigap plans often cover some or all of the 20% coinsurance. Medicare Advantage plans have their own rules and may cover wheelchairs through a different process — contact your plan directly to find out.

Repairs and replacements before five years

Medicare covers repairs to your wheelchair at no cost to you if the damage is not your fault. Normal wear and tear — like a flat tire, worn cushion, or loose armrest — is covered. You do not have to wait five years for a repair.

A replacement before five years is harder to get. Medicare will cover it only if the wheelchair cannot be repaired and the damage was not caused by misuse or neglect. For example, if a manufacturing defect makes the frame unsafe, Medicare may cover a replacement. If you dropped the wheelchair down stairs and broke the frame, Medicare will likely deny a replacement claim.

Your supplier or a repair technician must document the damage and explain why repair is not possible. Send this documentation to Medicare along with a new written order from your doctor. The review process is the same as for a new wheelchair, and approval is not may provide.

What happens if you need a wheelchair but cannot wait five years

If your current wheelchair is broken beyond repair and you need a replacement when ready, contact your supplier and ask them to submit a claim with documentation of the damage. Include a letter from your doctor explaining why you need a replacement urgently.

Medicare does not have a formal "emergency" process, but suppliers can request expedited review. This does not may provide approval, but it may speed up the decision. While you wait, you may be able to rent a wheelchair through a medical equipment rental company — some costs may be covered by Medicare or your supplemental plan.

If Medicare denies your early replacement claim, you have the right to appeal. Your supplier can help you file an appeal and gather the medical evidence you need. The appeal process takes several weeks, so this is not a quick solution.

Frequently Asked Questions

Can I get a wheelchair if I use a walker or cane?

Only if your doctor documents that a walker or cane is not enough — that you still cannot walk safely or far enough to move around your home. Medicare looks at your actual mobility, not just the equipment you currently use. If you can walk with a walker, you likely will not meet the medical necessity requirement for a wheelchair.

What if my wheelchair wears out after four years?

Repairs are covered at any time, even if you are close to your five-year mark. If the wheelchair cannot be repaired, you will need documentation from a technician and a new order from your doctor to request an early replacement. Approval is not may provide, but you can appeal if Medicare denies the claim.

Do I have to use a specific supplier?

No. You can choose any Medicare-enrolled DMEPOS supplier. Medicare pays the same approved amount to any supplier, so compare prices and customer service before deciding. Ask suppliers about delivery time, warranty, and whether they offer free repairs during the warranty period.

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

Medicare Advantage plans must cover wheelchairs, but the process and your costs may differ. Contact your plan to find out whether you need prior approval, which suppliers are in-network, and what you will pay out of pocket. Some plans cover wheelchairs through a different five-year schedule or require you to use specific suppliers.

Can Medicare cover a second wheelchair if I need one for different places?

No. Medicare covers one wheelchair per five-year period, regardless of how many you need. If you need a wheelchair for home and another for travel or outings, you would have to pay for the second one yourself. Some people use a lightweight manual chair for travel and a powered chair at home, but only one is covered by Medicare.