How Often Will Medicare Replace a Wheelchair?

Medicare helps beneficiaries access durable medical equipment (DME), including mobility aids like wheelchairs. These devices are for repeated use at home, assisting individuals with injuries, illnesses, or chronic conditions. Understanding Medicare’s guidelines for wheelchairs helps manage healthcare needs and costs.

Understanding Medicare Coverage for Wheelchairs

Medicare Part B, which covers medical insurance, includes wheelchairs as durable medical equipment (DME) when medically necessary. This means the equipment is required to diagnose or treat an illness or injury, meeting accepted medical standards. A doctor must provide a written order for the wheelchair’s use in the beneficiary’s home. This order follows a face-to-face examination by the treating physician to assess mobility limitations and determine the appropriate type.

Medicare Part B coverage involves the beneficiary paying 20% of the Medicare-approved amount after meeting the annual Part B deductible. For 2025, the Part B deductible is $257. Medicare-approved amounts are typically the lowest of the actual charge or the fee Medicare sets. Obtain the wheelchair from a Medicare-enrolled supplier who accepts assignment, agreeing to the Medicare-approved amount as full payment.

Medicare covers various types of wheelchairs, including manual, power, and scooters. For instance, a power wheelchair may be covered if a manual wheelchair is insufficient due to a lack of upper body strength. Medicare will not cover a wheelchair if it is solely needed for use outside the home or if mobility needs can be met with less costly equipment like a cane or walker.

Criteria for Wheelchair Replacement

Medicare defines a “reasonable useful lifetime” for most durable medical equipment, including wheelchairs, as typically five years from the date of delivery. After this period, Medicare generally covers replacement if the wheelchair is no longer serviceable and the individual continues to meet medical necessity criteria.

Specific exceptions allow for wheelchair replacement sooner than five years. If lost or stolen, Medicare may cover a replacement with reasonable proof, such as a police report. If damaged beyond repair due to an accident or natural disaster, replacement can be covered. This also applies if repair costs exceed replacement costs.

Another exception for early replacement occurs when the beneficiary’s medical condition changes, and the current wheelchair no longer adequately meets their needs. For example, if a manual wheelchair becomes insufficient due to a decline in physical ability, Medicare may cover a power wheelchair if medically necessary. The treating physician must document the change and issue a new order for the different type of equipment. Medicare typically covers repairs for existing equipment during its useful lifetime, up to the cost of replacement, before considering a full replacement.

Steps to Obtain a Wheelchair or Replacement

The process for obtaining a new wheelchair or replacement through Medicare begins with a visit to the treating physician. The doctor will conduct a face-to-face evaluation to confirm medical necessity and assess the individual’s ability to safely operate the device. The physician then provides a detailed prescription or written order specifying the type of wheelchair required, which is important for Medicare coverage.

Following the doctor’s visit, choose a Medicare-approved durable medical equipment (DME) supplier. Verify the supplier is enrolled in Medicare and accepts assignment to minimize out-of-pocket costs. Medicare provides online directories and a helpline to locate approved suppliers.

Once a supplier is selected, they typically handle claim submission to Medicare. This often includes submitting the doctor’s prescription and any other required medical documentation for medical necessity or replacement. For certain power wheelchairs, prior authorization may be required before delivery, which the supplier usually manages. After approval and delivery, the supplier may also provide fitting and training on how to use the wheelchair safely and effectively.