Medicare covers a new wheelchair once every five years, and repairs or adjustments as medically necessary

Medicare Part B pays for a wheelchair when your doctor says you need one for mobility inside your home. The program covers one wheelchair every five years — meaning if you received one in 2020, Medicare will not pay for a replacement until 2025. Repairs and adjustments to your existing wheelchair are covered separately and do not count against this five-year limit, as long as they are medically necessary and your wheelchair cannot be fixed to work safely.

The five-year rule applies whether you own the wheelchair outright or rent it. If you rent, Medicare pays the rental company directly. After five years, you can either continue renting month-to-month at your own cost, or start a new five-year rental period with Medicare coverage. Some people switch between owning and renting during their five-year window — for example, renting for two years and then buying — but the five-year clock does not reset when you change methods.

Key Takeaways

  • Medicare Part B covers one wheelchair every five years, whether you rent or own it.
  • Repairs and maintenance on your current wheelchair are covered separately and do not use up your five-year allowance.
  • Your doctor must document that you need a wheelchair for mobility inside your home; Medicare does not cover outdoor-only or recreational wheelchairs.
  • You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible; the supplier bills Medicare for the rest.
  • If your medical condition changes and you need a different type of wheelchair before five years pass, your doctor can request an exception, though approval is not may provide.

What Medicare considers medically necessary for a wheelchair

Medicare will only pay for a wheelchair if your doctor writes an order stating that you cannot walk safely or far enough to meet your daily needs, even with a walker or cane. The wheelchair must be for use inside your home — Medicare does not cover outdoor-only models or scooters meant primarily for community travel, though a scooter that you also use indoors may be covered.

Your doctor's order must include the type of wheelchair you need: a standard manual chair, a lightweight manual chair, a motorized chair, or a specialized model like a tilt-in-space chair for pressure relief. The order should explain why that specific type is necessary for your condition. If your condition changes — for example, you develop arthritis that makes manual propulsion impossible — your doctor can request a different type of wheelchair before your five years are up, but Medicare will review the request and may deny it if the change does not seem medically justified.

How the five-year timeline works in practice

The five-year period starts the day Medicare pays for your wheelchair, not the day you receive it. If Medicare approves and pays on March 15, 2023, your next wheelchair will be covered starting March 15, 2028. During those five years, you can have repairs and adjustments done as often as needed — new cushions, wheel replacements, brake adjustments, frame repairs — and Medicare will cover them if they are medically necessary and the wheelchair cannot be safely used without the repair.

If your wheelchair breaks down and cannot be repaired, you may be able to get an exception to the five-year rule. Your doctor and supplier must submit documentation showing that the wheelchair is permanently unusable and that you have no other mobility aid. Medicare reviews these requests case by case, and approval is not may provide. Some regional Medicare offices are more flexible than others, so the outcome can depend on where you live.

If you move to a different state or change Medicare Advantage plans, the five-year clock does not reset. Your new plan or regional office will see the same five-year history that your previous coverage had.

Renting versus buying: how it affects your coverage

Medicare pays rental companies a monthly fee for wheelchair rentals. After 13 months of rental payments, the rental company owns the wheelchair, and Medicare stops paying the rental company — but you can keep using the chair at no cost to you. If you want a different wheelchair after 13 months, you would need to buy it yourself or wait until your five-year period ends and Medicare covers a new one.

If you buy a wheelchair outright, Medicare pays the supplier a one-time amount based on the Medicare-approved price for that model. You pay 20 percent of that approved amount after meeting your Part B deductible; Medicare pays the rest. Buying is usually cheaper than renting if you plan to use the wheelchair for more than a few months, but it means you are responsible for repairs and maintenance costs after Medicare's coverage ends.

Some people rent for the first year or two to see which type of wheelchair works best, then buy a new one before the rental period ends at 13 months. This strategy lets you use Medicare coverage twice — once for the rental and once for the purchase — within your five-year window, though you will pay 20 percent of the purchase price out of pocket.

What you pay out of pocket

You pay 20 percent of the Medicare-approved amount for the wheelchair after you meet your Part B deductible for the year. The deductible is the same whether you are getting a wheelchair, a walker, or any other durable medical equipment. Once you meet it, you pay 20 percent of approved costs for the rest of the calendar year.

The actual cost to you depends on the type of wheelchair. A basic manual wheelchair might have a Medicare-approved amount of $800, meaning you would pay $160 after your deductible. A motorized wheelchair might be approved at $6,000 or more, meaning your 20 percent share could be $1,200 or higher. Some suppliers charge more than the Medicare-approved amount; if they do, you may owe the difference on top of your 20 percent.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower. Medigap plans often cover the 20 percent coinsurance. Medicare Advantage plans have their own cost-sharing rules, which vary by plan. Check your plan documents or call your plan to find out what you will pay.

How to request a wheelchair through Medicare

Your doctor must order the wheelchair and document the medical reason. You cannot request one directly from Medicare. Once your doctor writes the order, you choose a Medicare-approved supplier — you can find one by searching the Medicare supplier directory on Medicare.gov or by asking your doctor for a recommendation.

The supplier will contact Medicare to confirm coverage and get approval before ordering your wheelchair. This process usually takes one to two weeks. Once approved, the supplier will deliver and fit the wheelchair to you. You will receive a bill for your 20 percent coinsurance after you meet your deductible.

Keep records of the date Medicare paid for your wheelchair. You will need this date to know when you become may be able to access for a new one. If you change suppliers or move, bring this documentation with you so the new supplier can see your five-year history.

What happens if you need a wheelchair before five years are up

If your medical condition changes significantly — for example, you lose the use of your arms and can no longer propel a manual wheelchair — your doctor can request an exception to the five-year rule. The request must explain why your current wheelchair is no longer safe or effective and why a different type is medically necessary now.

Medicare reviews these requests through your regional Medicare Administrative Contractor. Approval is not automatic. Some contractors are more willing to grant exceptions than others, and decisions can take several weeks. If Medicare denies the request, you can file an appeal, though the process is lengthy.

If you straightforward want a newer model or a different color, Medicare will not cover it before five years have passed. You would need to purchase it yourself or wait until your five-year period ends.

Frequently Asked Questions

Can I get a motorized wheelchair if I currently use a manual one?

Yes, if your doctor documents that your medical condition has changed and you can no longer safely propel a manual wheelchair. Your doctor must write a new order explaining the change. Medicare will review it, and approval depends on whether the medical reason is documented clearly. This counts as an exception to the five-year rule.

What if my wheelchair gets stolen or damaged in an accident?

Damage from accidents or theft is not covered by Medicare. You would need to repair or replace it at your own cost, or wait until your five-year period ends. Some homeowner's or renter's insurance policies cover durable medical equipment; check your policy to see if a wheelchair is included.

Do I have to use a Medicare-approved supplier?

Yes. Medicare will only pay if you use a supplier enrolled in the Medicare program. You can find approved suppliers through the Medicare supplier directory or ask your doctor for a referral. Using an unapproved supplier means you pay the full cost yourself.

If I rent for 13 months and then buy a new wheelchair, does that count as two separate five-year periods?

No. Both the rental and the purchase happen within the same five-year period. The five-year clock started when Medicare first paid for your mobility aid, whether that was a rental or a purchase. You cannot use Medicare coverage twice by switching from rental to purchase within those five years.

What if I move to a different state?

Your five-year history follows you. The new regional Medicare office will see that you received a wheelchair on a specific date and will explore the same five-year rule. You will not be able to get a new wheelchair covered until five years have passed from the original date, regardless of which state you live in.