Medicare is Making It Easier for Mobility Users to Get a New Wheelchair

If you or a loved one is a mobility user, you understand how getting custom mobility equipment through insurance can be a complex and lengthy process. Between the paperwork, multiple doctor visits, and mobility evaluations from certified seating specialists, it could significantly delay your access to mobility freedom.

To make things even more complicated, when you become eligible for an upgrade after five years, Medicare will require you to complete this lengthy process again. In the summer of 2025, Medicare decided to update this rule to serve you better and streamline access to the equipment you rely on. Keep reading to learn what’s changed and how it could affect your next wheelchair order.

What Changed (and Why It Matters to You)

Previously, if you replaced your equipment with no additional changes, you were likely still required to complete a face-to-face evaluation with your doctor. This created headaches and caused significant delays for those simply seeking an identical replacement wheelchair model.

With Medicare’s new rule, if your power wheelchair has reached the five-year “reasonable useful lifetime” and you’d like to keep the same wheelchair model, you don’t need to restart the process. Because your existing model was already deemed medically necessary and previously billed, Medicare won’t require you to complete another face-to-face evaluation.

This new rule helps reduce the burden on you, your loved ones, and your care team. It also creates an opportunity for your provider to obtain approvals and deliver your new chair sooner.

Why You Should Still Notify Your Care Team

While opting out of another medical evaluation saves time, it’s still a good idea to check in with your care team regarding your mobility needs.

Just as you complete annual physicals with your doctor, get vision exams once a year, and see your dentist twice a year, your mobility needs deserve the same regular attention.

Five years is a long time, and your mobility needs could change. Scheduling a brief follow-up with your care team will help ensure your equipment continues to meet your needs.

What If You Want to Add New Features?

If you’re adding additional features to your wheelchair or transitioning from a manual to a power wheelchair, you will likely need to complete another face-to-face evaluation.

If you’re a current power wheelchair user and now qualify for a seat elevation system, a face-to-face evaluation will not be required because medical necessity has already been established for your equipment. Currently, this looks like it’s the only exception.

While you don’t need your doctor to submit another written order of medical necessity for the new equipment, you still need to be evaluated by a seating specialist. This ensures any additional features will continue offering you the same safety and support as your current wheelchair.  

By removing the need to be re-evaluated by your doctor, you don’t have to restart the entire process, making things easier, faster, and more streamlined.

How to Get Started

Step 1: 

Talk to your provider when your chair nears the five-year mark.

Step 2: 

Ask whether you qualify for an identical replacement.

Step 3: 

If your needs have changed, discuss upgrades or adjustments.

Step 4: 

Have your doctor complete the written order and confirm the continued need.

Step 5: 

Contact your mobility specialist about your replacement options.

The Bottom Line

Medicare’s updated rule is a big win for mobility users, making the process of replacing your wheelchair simpler and faster.

By removing unnecessary steps for identical replacements, you can spend less time navigating paperwork and more time enjoying the freedom your equipment provides.

Remember, staying in touch with your care team ensures your mobility needs are always met—whether you’re sticking with the same model or exploring new features.