Does Medicare Cover Mobility Scooters?
Yes, Medicare covers mobility scooters as long as you meet certain eligibility requirements. Scooters are considered durable medical equipment (DME), medically necessary items a healthcare provider orders for a patient’s long-term use.
To qualify as a DME, the item must be:
- Durable and able to withstand repeated use
- Used for a medical reason
- Appropriate for use in your home
- Expected to last at least three years
- Prescribed by your primary care provider
For individuals with limited mobility, scooters can significantly improve their quality of life. Medicare’s coverage can help pay for a necessary item that is not always affordable.
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On The Go With Mobility Scooters
Mobility scooters offer independence and freedom to those who struggle with mobility, whether due to aging, an accident, or a disability. However, these devices can be expensive. And for those already dealing with financial stress due to medical expenses, the cost of a mobility scooter can be a significant barrier to their increased autonomy. For this reason, Medicare coverage for mobility scooters is crucial since it offers much-needed relief for those in need of these life-changing devices.
How Do Mobility Scooters for Medicare Work?
Not everyone is eligible for mobility scooter Medicare coverage. You must meet specific requirements, such as having a doctor’s prescription and being diagnosed with a particular health condition.
Here are the eligibility requirements for getting approved for a mobility scooter. Note that you must meet all of the following criteria to be eligible.
- You have limited mobility. Limited mobility is the inability to move one or more of your extremities freely and painlessly.
- You are diagnosed with a specific health condition. You must be officially diagnosed with a specific medical condition that prohibits or makes moving around in your home difficult.
- You’re unable to do daily living activities. If you struggle to do necessary daily activities such as going to the bathroom, kitchen, etc., even with the help of a cane or walker, you may be eligible for a mobility scooter.
- You can safely operate the equipment. You must be able to safely operate the equipment on your own or have someone with you who can help you use the device.
- Your living space has room for the equipment. Your doctor or supplier must visit the home and approve it for the scooter, which can mean a few different things, such as ensuring it can fit through doorways.
Manual vs. Power Wheelchair vs. Scooters
By understanding the differences between manual wheelchairs, power wheelchairs, and mobility scooters, you can choose the right mobility product for your needs.
- Manual wheelchair: Manual wheelchairs are designed to be propelled by the person in the wheelchair or be pushed by a caretaker.
- Power wheelchair: Also known as electric wheelchairs, power wheelchairs are powered by an electric motor.
- Scooters: The main difference between mobility scooters and power wheelchairs is that the former comes with a tiller and handlebars, whereas the latter is usually operated using a joystick. Power wheelchairs may also be more suitable for indoor use than scooters.
Medicare covers manual wheelchairs, power wheelchairs, and scooters. Your doctor can help you determine which option will most benefit you.
Understanding Medicare Coverage for Mobility Scooters
There are four parts of Medicare: Part A, Part B, Part C, and Part D. Each part’s mobility scooter coverage is as follows:
- Medicare Part A: Medicare Part A covers inpatient hospital care, hospice, skilled nursing facility, and home health care. However, it does not cover mobility scooters.
- Medicare Part B: Medicare Part B covers diagnostic tests, doctor’s visits, preventive care, outpatient care, and durable medical equipment, including mobility scooters.
- Medicare Part C: Also known as Medicare Advantage, Medicare Part C is offered by private companies. It combines Medicare Part A and Part B coverage into one. Because Part C must offer at least the same coverage as Original Medicare, it does cover mobility scooters.
- Medicare Part D: Medicare Part D plans cover outpatient prescription drug costs. You do not automatically get Medicare Part D with Medicare. Private insurance companies sell it, and you’ll need to sign up for it separately. It does not cover mobility scooters.
As you can see, Medicare Part B and Medicare Part C each offer coverage for mobility scooters. However, since you can not have both Original Medicare and Medicare Advantage simultaneously, whichever you do have will offer coverage alone.
How Much Do Mobility Scooters Cost With Medicare?
Mobility scooters range widely in cost, usually falling between $900 and $4,000 without insurance. If you purchase a Medicare-covered mobility scooter, Medicare will pay 80% of the cost, while you pay the remaining 20% after paying the Part B deductible for the year. The 2023 Medicare Part B deducible is $226 for the year. Medicare may also cover repairs and replacement parts.
Suppose you choose a scooter that costs $2,000. You will pay the $226 deductible and 20% of the total cost, which comes out to $400. This would bring your total to $626, a much lower cost than the overall cost of the mobility scooter.
If you rent instead of purchase, Medicare will also cover a portion of your monthly payments for the use of the equipment. How long this monthly payment coverage continues will vary based on the type of equipment you rent.
Medicare Advantage Costs
Because Medicare Advantage Plans must cover the same medically necessary items as Original Medicare (Part A and Part B), you would also get most of the costs covered by your Medicare Advantage plan. Note that your specific costs will depend on your particular policy. Ask your agent for more details on how much a mobility scooter would cost you.
Getting Approved for a Mobility Scooter
Here’s the step-by-step process of how to get approved for a mobility scooter.
- Assess Your Mobility Needs: Before considering a mobility scooter, evaluate your mobility situation to determine whether it’s necessary. For example, if you’re struggling to perform daily activities around the house on your feet, you may need a mobility scooter. But if you can move around the house with the help of a walker or cane, a scooter may not be necessary.
- Consult With Your Doctor: If you need a mobility scooter, speak to your doctor or primary care provider (PCP) and schedule a face-to-face office visit.
- Undergo a Medical Evaluation: During the office visit, you may undergo a medical evaluation where your PCP will determine whether you need a scooter based on your condition.
- Obtain Prescription: If your primary care provider determines that it’s medically necessary that you use a mobility scooter, they should sign a prescription or certificate indicating your medical need for it.
- Document Medical Necessity: Beyond the prescription, you may need supporting documentation, such as medical records, test results, etc. Your primary care provider should know what documents are required for the item you need.
- Select a Medicare-Approved Supplier: Once you have your primary care provider’s prescription, you must take it to a Medicare-approved supplier to receive coverage. Contact your Medicare plan to find out which suppliers you could use.
- Obtain Prior Authorization, If Needed: You may need prior authorization to be covered for certain types of equipment. Contact Medicare to determine if it’s necessary and what steps to take.
What to Do if Your Prior Authorization Request is Denied
After Medicare receives the prior authorization documents, they’ll send a decision letter to your mobility scooter supplier.
Your prior authorization request could be denied if:
- You do not medically require a mobility scooter.
- Medicare did not receive all the necessary information to make a decision.
- Medicare needs more information to make a decision, and your DME supplier needs to resubmit your prior authorization request.
Contact your mobility scooter supplier or call 1-800-MEDICARE (1-800-633-4227) if you have any questions or want to appeal the decision. TTY users can call 1-877-486-2048.
The Benefits of Mobility Scooters
The benefits of mobility scooters are plenty. Some of those benefits are as follows:
- Increased Independence: With the help of mobility scooters, those with trouble getting around can now enjoy increased independence inside and outside the home.
- Enhanced Mobility: Some mobility scooters can travel up to 50 km per single charge, allowing you to travel long distances easily.
- Improved Quality of Life: With a mobility scooter, you can move around independently without relying on others. This increased autonomy and mobility could encourage you to maintain your social life, which prevents feelings of isolation.
- Increased Safety: Some mobility scooters have safety features such as lights and reflectors, which can protect you from accidents when traveling outdoors or in dimly lit areas.
- Reduced Physical Strain: Unlike traditional wheelchairs, mobility scooters are electric and do not require you to manually propel them, preventing physical strain and injury.
Alternative Ways to Pay For a Mobility Scooter
If you’re not eligible to receive coverage from Medicare for a scooters, consider exploring the following options to help you pay for one.
- Private Insurance: You may have coverage through your private health insurance. Review your policy to see your coverage options and eligibility requirements.
- Medicaid: Medicaid is a joint federal and state program that provides health coverage to those with limited income and may cover mobility scooters if deemed medically necessary.
- Self-Payment: If you do not wish to invest in private health insurance, paying out-of-pocket may make more financial sense than monthly health insurance premiums.
- Community Health Programs: Charities or community health programs such as MedShare and the American Medical Resource Foundation may assist those who need mobility aids.
All in All
Mobility scooters can be costly if you pay out of pocket. Thankfully, Medicare covers up to 80% of the cost if the mobility scooter is medically necessary and you receive a prescription from your primary care provider. But if you’re not eligible for coverage, do not worry. Consider exploring other ways to help pay for the device, such as community health programs, Medicaid, and private health insurance plans.