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

Medicare Part B pays for a wheelchair or motorized scooter if a doctor documents that you cannot walk safely without one. The coverage limit is one device every five years. If your current wheelchair breaks or no longer fits your body, you may be able to get a replacement sooner, but Medicare will review the reason and may deny it if the device is still usable.

The five-year rule is a hard limit, not a guideline. If you received a wheelchair in January 2020, Medicare will not cover another one until January 2025, even if your needs have changed. Some people work around this by paying out of pocket for repairs or a second device, but Medicare will not reimburse you for a wheelchair you bought on your own.

Key Takeaways

  • Medicare Part B covers one wheelchair or scooter every five years if your doctor prescribes it as medically necessary.
  • Your doctor must document in writing that you cannot walk safely in your home without the device, not just that it would be convenient.
  • Repairs and replacement parts are covered separately from the five-year limit, so a broken wheel or cushion does not count against your next device.
  • If your wheelchair is damaged beyond repair within the five-year window, you will need to appeal to Medicare with evidence that it cannot be fixed.
  • You pay 20 percent of the approved amount after you meet your Part B deductible; the supplier bills Medicare for the rest.

What Medicare considers medically necessary

Medicare does not cover a wheelchair just because walking is hard or tiring. A doctor must write an order stating that you cannot walk safely indoors without one. "Cannot walk safely" means you are at high risk of falling, you lose your balance, or you cannot bear weight on your legs — not that you prefer not to walk or that walking causes pain.

The doctor's order must be specific: it should say whether you need a manual wheelchair, a motorized scooter, or a power wheelchair, and it should describe your condition. A note that says "patient needs wheelchair" is not enough. Medicare will ask the supplier to send the doctor's full medical record, and if the documentation does not match the device, Medicare may deny the claim.

Your doctor does not have to be a specialist. Your primary care doctor, a neurologist, a rheumatologist, or any licensed physician can write the order. If you see a physical therapist, they cannot write the order themselves, but they can recommend one to your doctor.

How the five-year replacement cycle works

Medicare tracks the date you received your last wheelchair. Five years from that date, you become may be able to access for a new one. The date is based on when the supplier delivered it to you, not when your doctor wrote the order or when you paid for it.

If you need a wheelchair before five years have passed, you can request an exception. Medicare calls this a "replacement due to loss, theft, or irreparable damage." You will need to provide proof: photos of the damage, a repair estimate showing it cannot be fixed, or a police report if it was stolen. Even with proof, Medicare may decide the device can be repaired instead and cover the repair cost.

The five-year clock resets when you receive a new device. If you get a replacement wheelchair in year three, your next may be able to access date is five years from that replacement date, not five years from your original device.

Repairs and parts are separate from the five-year limit

Medicare covers repairs and replacement parts — wheels, cushions, armrests, footrests, batteries — without counting against your five-year limit. If your wheelchair cushion wears out, you can have it replaced. If the motor on your scooter fails, Medicare covers a new motor. These do not reset the five-year clock.

Your supplier or a wheelchair repair shop can submit the repair claim to Medicare. You will pay 20 percent of the approved amount after your Part B deductible. Some repairs are covered as often as needed; others have their own limits. For example, Medicare covers cushion replacement once per year.

If repairs become very expensive or frequent, that can be a reason to request an exception for a new device before five years. Keep records of all repair costs and dates. If you spend more on repairs than a new wheelchair would cost, show that to Medicare when you appeal.

What you pay and how to find a supplier

You pay 20 percent of Medicare's approved amount for the wheelchair or scooter after you meet your Part B deductible for the year. The supplier bills Medicare for the rest. The approved amount varies by region and by device type; a basic manual wheelchair might be approved at $800, while a motorized scooter could be $2,000 or more.

You must use a Medicare-enrolled supplier. Not all medical equipment companies are enrolled. You can search for suppliers on the Medicare website by entering your ZIP code, or you can ask your doctor for a referral. Some suppliers will deliver and fit the device at your home; others require you to pick it up.

Before you order, ask the supplier what the Medicare-approved amount is for the specific device your doctor prescribed. Ask whether they will bill Medicare directly or whether you will pay upfront and submit a claim yourself. Most suppliers bill Medicare directly, which is simpler for you.

When Medicare may deny a wheelchair claim

Medicare denies wheelchair claims most often because the doctor's order does not clearly state medical necessity. If the order says "patient wants a wheelchair" or "mobility aid recommended," Medicare will ask for more information. The doctor must explain why you cannot walk safely without it.

Medicare may also deny a claim if you already have a wheelchair that is less than five years old and still usable. If you request a second device or an upgrade before five years, Medicare will review whether your condition has changed enough to justify a second device. This is rare and requires strong medical evidence.

If Medicare denies your claim, the supplier will send you a notice explaining why. You have the right to appeal. You can ask your doctor to provide more detailed documentation, or you can ask a social worker or physical therapist to write a letter supporting the need. Many appeals are approved after additional information is submitted.

Manual wheelchairs versus motorized scooters and power chairs

Medicare covers manual wheelchairs, motorized scooters (three- or four-wheeled), and power wheelchairs. The device your doctor prescribes depends on your strength, balance, and where you use it. A manual wheelchair requires upper body strength to push. A scooter is easier to operate but takes up more space. A power wheelchair offers the most control but is the heaviest and most expensive.

Your doctor's order should specify which type you need. If your doctor writes "wheelchair" without specifying, the supplier will ask for clarification. Medicare will not cover an upgrade from a manual to a motorized device unless your condition has changed and your doctor documents that you can no longer use a manual chair safely.

Accessories like cushions, backrests, and trays are covered separately. Some are included in the base price; others are billed as add-ons. Ask the supplier which accessories are covered by Medicare and which you would pay for out of pocket.

What to ask your doctor and when to contact Medicare

Before you see your doctor, write down why you need a wheelchair: Do you fall without support? Do you lose your balance? Can you not bear weight on your legs? Be specific. When you see your doctor, ask them to write an order for a wheelchair and to include the reason you need it for safety in your home.

Ask your doctor which type of device — manual, scooter, or power chair — is right for your condition. Ask them to send the order directly to the supplier you choose, or ask for a copy to give to the supplier yourself.

Once you have the order, contact a Medicare-enrolled supplier. Ask them to verify that Medicare will cover the device before you commit to it. If Medicare denies the claim, ask the supplier to send you the denial notice and the reason. You can then contact Medicare directly at 1-800-MEDICARE to ask about appealing, or you can ask your doctor to provide more information.

Frequently Asked Questions

Can I get a new wheelchair if my old one is broken but not completely unusable?

Medicare will cover repairs first. If the repair cost is very high or the chair cannot be safely repaired, you can request an exception for a replacement before five years. You will need a repair estimate or a letter from a technician stating the damage is irreparable. Medicare reviews these requests case by case.

What if I need two wheelchairs — one for home and one for travel?

Medicare covers one device every five years. You cannot get a second wheelchair under Medicare coverage within that five-year window, even if you use them in different places. You would need to pay for a second device out of pocket.

Does Medicare cover a wheelchair if I only need it outside my home?

No. Medicare covers wheelchairs for use in your home. If you need mobility help only when you are out in the community, Medicare does not cover it. Your doctor's order must state that you need the device for safety indoors.

Can I choose any wheelchair I want, or does Medicare limit the type?

Your doctor prescribes the type based on your medical need. Medicare covers standard manual wheelchairs, scooters, and power wheelchairs. Specialized or custom devices may not be covered, or Medicare may cover only the base model and require you to pay extra for upgrades or custom features.

What happens if I move to a different state — does the five-year clock reset?

No. The five-year limit is based on the date you received the device, not your location. If you move, your Medicare coverage stays the same, and the five-year clock does not change.