Getting Around Safely Starts With Knowing the Rules
If walking around your own home has become harder, you may be thinking about a wheelchair, power chair, or mobility scooter. Before you call a supplier, it helps to understand how Medicare actually handles these devices. The rules are specific, and a lot of claims get denied simply because a step was missed early on. Here's what to know so you can get the right equipment without a costly surprise.
Mobility Devices Fall Under Durable Medical Equipment
Medicare Part B covers wheelchairs, power wheelchairs, and scooters as durable medical equipment, or DME, when they're medically necessary for use inside your home. Once you meet the Part B deductible, which is $283 in 2026, you typically pay 20% of the Medicare-approved amount (if you have a Medicare supplement plan, your share may be less). Your supplier has to be enrolled in Medicare and willing to accept assignment, or you could end up paying more than expected.
A Face-to-Face Exam Comes Before the Equipment
Medicare doesn't approve a wheelchair (manual or electric) or scooter just because walking is tiring or painful. Your doctor has to examine you in person and document that your condition significantly limits your ability to do one or more mobility-related daily activities in your home, like getting to the bathroom or getting dressed. If you are able to get around your home without a mobility device and only need one for use outside the home, Medicare will not cover it.
The paperwork also has to show that a cane, walker, or manual wheelchair genuinely isn't enough to meet that need safely. Once the doctor has examined you, he or she writes a prescription, called a Standard Written Order, for the mobility device. In the case of a manual wheelchair, the DME supplier does not need to have the Standard Written Order in hand prior to providing the manual wheelchair to you. However, for power mobility devices, the rule is different—the DME supplier must receive the Standard Written Order before providing the power device. And for all types of mobility devices, the DME supplier must have the Standard Written Order before billing Medicare; otherwise, Medicare will deny the claim.
Medicare Picks the Least Costly Option That Works
Here's a detail many people don't expect: Medicare covers the least expensive device that meets your medical needs, not necessarily the one you'd prefer. A scooter uses tiller-style steering and requires decent upper body strength and balance to operate safely. A power wheelchair, controlled by a joystick, is typically approved when a scooter isn't a safe fit. If a scooter would work for you, Medicare generally won't also cover a power wheelchair on top of it.
Some Power Wheelchairs Need Prior Authorization
Certain power wheelchairs and scooters require prior authorization before Medicare will pay its share. Your supplier submits the request and supporting documents to the DME Medicare Administrative Contractor, which usually responds within 10 business days. If the request is denied, your provider can resubmit with more detail.
Renting, Buying, and Choosing a Supplier
For most higher-cost equipment like wheelchairs, Medicare typically pays a supplier to rent the item to you for up to 13 months, after which ownership transfers to you. There are exceptions, such as for customized wheelchairs or scooters and complex rehabilitative power wheelchairs, where you are offered the option to purchase the device upfront.
Always confirm your supplier participates in Medicare and accepts assignment for every month of a rental, not just the first one. If a supplier doesn't accept assignment, you may have to pay the full cost upfront and wait for Medicare to reimburse its portion. Additionally, a DME supplier that doesn't accept assignment can charge any amount they want above the Medicare allowable amount, which you would be responsible for paying. (This rule is different from physicians and other practitioners: those who don't accept assignment can't charge more than 15% above the Medicare allowable amount.) And if you have a Medicare supplement plan, that plan will only pay the coinsurance of the Medicare allowable amount, not the additional charge from the DME supplier.
Don't Forget Repairs, Parts, and Replacement Timelines
Coverage doesn't stop once you have the equipment. If you are within the 13-month rental cap period, all maintenance, repairs, replacement parts, and labor are covered by the DME supplier as part of the rental agreement. If you own a Medicare-covered wheelchair or scooter, Medicare can help pay for repairs and replacement parts when they're reasonable and medically necessary because of normal wear or an accident. In most cases, Medicare doesn't cover routine maintenance, such as cleaning and periodic adjustments or inspections, once you own the device. Keep records of when you received the device and any repairs or replacement of parts, since suppliers and Medicare may ask for that history if you need a repair or eventually qualify for a replacement.
Medicare may cover a total replacement of the device in some circumstances, such as when the device is damaged beyond repair, is at least five years old and is no longer usable, or is lost or stolen, and you have proper documentation.
Medicare Advantage Plans May Handle Things Differently
If you're enrolled in a Medicare Advantage plan instead of Original Medicare, your plan has its own network of DME suppliers and may have its own prior authorization process, even for equipment that wouldn't require it under Original Medicare. Your out-of-pocket costs, annual limits, and covered supplier list can all look different depending on your specific plan. It's worth a call to your plan, or to us, before you commit to a particular supplier.
Talk to Your Doctor Before You Talk to a Supplier
The most common reason mobility device claims get denied isn't a supplier problem. It's incomplete documentation from the very first appointment. If you're struggling with mobility at home, bring it up directly with your doctor and ask what type of device might fit your situation, well before you contact a DME supplier. Ask specifically what your doctor is documenting about your home layout, your daily activities, and why a cane or walker won't safely meet your needs. That conversation, held early, is critical as to whether your claim gets approved.
We Can Help You Sort Through the Costs
Between the Part B deductible, the 20% coinsurance, the additional charge from a supplier who doesn't accept assignment, and whether costs such as repairs, replacement, and maintenance are covered, not to mention the different rules for Original Medicare versus Medicare Advantage, it's easy to feel unsure about what you'll actually owe. Additionally, the Medicare rules around coverage are quite complex; this article is not intended to discuss all aspects of coverage. If you have questions about how your specific plan handles mobility equipment, or whether a Medigap policy could help with your share of the cost, reach out.
We're happy to walk through your options with you.
