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Does Medicare Cover Power Mobility Scooters?

by Guest Blogger
written by Guest Blogger

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.

Summary

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.

Power Scooters Offered by Senior.com

 

 

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What Medical Equipment is Covered by Medicare?
Medicare Plans

What Medical Equipment is Covered by Medicare?

by Garrett Ball
written by Garrett Ball

 
As you age, certain medical equipment may be necessary. If you use durable medical equipment (DME) and/or medical supplies which assist you in your daily functions, those items may be covered by Medicare Part B. Be aware that Medicare covers the basic model of that equipment. If you want to add on expensive upgrades, you typically will have to pay for any extra charges. What Medical Equipment is Covered by Medicare?

What Durable Medical Equipment (DME) is Covered by Medicare?

Some DME items must be purchased and other items can be rented. Generally, after 13 months of renting equipment, you will be able to own it. However, although oxygen equipment is always rented, you cannot purchase it. See below for a list of DME equipment and supplies that are covered when medically necessary:

  • Air-fluidized beds and other support surfaces (for rental use only)
  • Blood sugar monitors
  • Blood sugar (glucose) test strips
  • Canes (except white canes for the blind)
  • Commode chairs
  • Continuous passive motion (CPM) machine
  • Crutches
  • Hospital beds
  • Incontinence products
  • Infusion pumps and supplies (if necessary to administer certain drugs)
  • Manual wheelchairs and power mobility devices
  • Nebulizers and nebulizer medications
  • Oxygen equipment and accessories
  • Patient lifts
  • Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
  • Suction pumps
  • Traction equipment
  • Walkers

What Durable Medical Equipment (DME) is NOT Covered by Medicare?

  • Medicare will not pay for durable medical equipment which is used outside of the home. If you do not need it for assistance at home, then it will not be covered. An example would be a motorized scooter for use outside the home only, given that you can get around your house without it
  • Items only intended for ease or comfort, i.e. stairway elevators, grab bars, air conditioners, bathtubs and toilet seats
  • Any modifications made to your home, i.e. ramps, widened doors, to facilitate wheelchair access
  • Equipment not suitable for home use, i.e. paraffin bath units and oscillating beds
  • Disposable items or items not used with equipment, incontinence pads, catheters, surgical face masks, or compression leggings. Note: If you get home health care, Medicare will pay for some of these items as part of your benefit, such as intravenous supplies, gauze, and catheters.

There are criteria that the DME must meet prior to being approved by Medicare, as follows:

  • It must be “durable”, resilient and long-lasting
  • It must be medically necessary and prescribed by your physician or other health care provider to be used at home. Note: It cannot be more than 6 months before the date of the order
  • It must not be used by someone else who isn’t sick or injured
  • It must be strong enough to withstand repeated use and last for at least 3 years.

Special Requirements for Certain DME Items

There are special rules for items that are more expensive, some examples are below:
Wheelchairs: Your healthcare provider’s order should indicate the following:

  • that it is difficult for you to manage at home with just a cane or a walker. You must also be having difficulties in your daily functioning as getting dressed or bathing.
  • the date of your office visit
  • that you can use the wheelchair safely.

Power scooters:

  • The scooter must be ordered within 45 days of your healthcare provider’s prescription. His order will have to stipulate that you have the same problems listed above for getting a wheelchair. However, the order must also stipulate that you can’t use a manual wheelchair but could safely use a powered one.

Please note that some states have additional rules and required forms for wheelchairs and scooters. Check with your doctor to be sure you follow those rules.

How Do You Get Durable Medical Equipment (DME) Covered by Medicare?

You must get your DME from a Medicare-approved supplier. Both Original Medicare and Medicare Advantage plans have approved lists of suppliers. To find them in your area, go to the supplier directory at www.medicare.gov/supplierdirectory/search.html. You will need to use suppliers that are “approved” by your plan – either original Medicare or Medicare Advantage.
Medigap plans will also cover DME if Medicare approves it. It will be covered as a normal Part B charge – the Medicare Part B deductible will apply if you have a Medigap plan that does not cover the deductible. But after that Medicare and the Medigap plan should cover your costs in full for covered equipment.

DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

Competitive Bidding Program:

After suppliers submit their bids to provide certain DME and supplies in competitive bidding areas, an amount is agreed upon by Medicare for payment of each item. Medicare contract suppliers are selected from the suppliers with winning bids.

  • This program is cost-effective. Its primary goal is to save Medicare and its beneficiaries money.
  • It operates in certain zip codes in the Northeast, South, Midwest and West.
  • It ensures that you get top quality products from Medicare-approved suppliers.
  • It helps to minimize fraudulent and abusive practices in the Medicare system.

If you have questions about what Medicare will or will not cover, it is best to contact Medicare directly before agreeing to pursue purchasing or renting any equipment. You can find some information on Medicare’s website or by calling them at 1-800-MEDICARE.
Senior.com does not accept Medicare. However, our customers regularly get prior approval from Medicare for DME products and then submit the receipt with proper paperwork for reimbursement to Medicare.
 

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