Power scooters increase mobility to make everyday tasks possible again for many individuals. They are a great choice for this, but they are quite expensive.
Medicare will provide coverage for mobility scooters if you are able to meet certain requirements. Scooters and wheelchairs are considered durable medical equipment, which is covered under Medicare Part B.
If you follow the steps we’ve listed below, you can increase your chance of getting Medicare to pay for your scooter.
DME Guidelines from Medicare
Medicare Part B covers 80% of outpatient medical expenses whenever they are deemed medically necessary. Whenever a piece of equipment is expensive, proving medical necessity starts with your Medicare doctor writing an order for this equipment.
Medicare requires that you meet with your doctor in person. He must assess that you have a chronic or permanent health condition that makes a mobility scooter necessary for you to get in and around your own home. Medicare Part B will not cover your power scooter if you are living in an assisted living or nursing home facility.
Your doctor needs to also provide documentation showing that other less expensive devices like canes or walkers will not sufficiently meet your mobility needs.
Assistance with Activities of Daily Living
There are a number of activities of daily living that are related to mobility. This includes being able to prepare and eat meals, take a bath, use the toilet or move around your home from one room to another.
Your power scooter will be considered reasonable and necessary if you are unable to perform these activities of daily living safely and in a timely manner without it.
Medicare Defaults for DME
There are several types of DME that can help with mobility. Medicare will want to first provide the least expensive equipment that meets your needs. Obviously, mobility scooters are some of the most expensive types of DME, so Medicare will only cover it if all other DME won’t do the job.
For example, if your upper body strength is sufficient to operate a manual wheelchair, Medicare will provide you with that instead of a mobility scooter.
There are also requirements that you use an approved DME supplier that has a staff member who specializes in wheeled mobility equipment. This professional will be quite familiar with the various rules and requirements for power scooters and will also have the knowledge and experience to select a mobility device that you can not only qualify for but can also safely operate in your own home.
Medicare will want you to see a physical therapist or occupational rehabilitation therapist to be thoroughly evaluated for use of a scooter. This is helpful to you as well because your therapist can gather the necessary information and document the reasons why you should qualify for a scooter.
You must also be properly evaluated to qualify for a scooter through Medicare. Usually, you will need to make an appointment with either an Occupational or Physical Therapist to complete this step. They will gather the information and documentation Medicare requires to qualify someone you a mobility scooter.
What Medicare Pays for a Mobility Scooter
Part B has an annual deductible which you must first satisfy before Medicare begins paying outpatient benefits. Once the deductible is met, Medicare will pay 80% of your covered expenses ad you will pay the rest. This is called your coinsurance.
Many Medicare beneficiaries enroll in Medicare supplement insurance to help them pay for these gaps. Medicare supplements pay after Medicare first pays its share. This coverage can be used at any provider nationwide that accepts Medicare. Depending on the standardized plan that you choose, you may have nothing to pay afterward or you may have a small amount of cost-sharing.
These plans have no networks which make it easy to use them anywhere. They do not include drug coverage, but a standalone Part D drug plan can be purchased alongside them.
Some beneficiaries choose to get their benefits through a Medicare Advantage plan instead of through Medicare itself. These plans have networks and contract their own DME vendors. If you have this kind of coverage, the insurance company that provides your plan will have its own requirements and guidelines that it uses to determine if the scooter is truly medically necessary for you. You can consult the plan’s Summary of Benefits to determine your cost-sharing under the plan. Under many Advantage plans, you could pay as much as 20% of the cost of your scooter, but not more than the plan’s out-of-pocket maximum.
While this type of coverage may not pay for as much as a comprehensive Medicare supplement Plan F or G, Medicare Advantage plans do typically have lower premiums than Medicare supplements.
It’s up to you to choose the type of supplemental coverage that best fits your needs and budget for the long term.
Ensuring that your power mobility scooter will be covered by Medicare requires a number of steps along the way. Nonetheless, if you meet the requirements for medical necessity, Medicare can and does offer coverage so that you can easily get around your own home.
Danielle K Roberts is a member of the Forbes Finance Council and is the co-founder of Boomer Benefits, a licensed insurance agency that helps baby boomers navigate their Medicare benefits.