Does Medicare Cover Mobility Scooters?
When moving around becomes painful or difficult due to limited mobility, a mobility scooter can help you keep your independence. But these assistive devices can be expensive, often costing thousands of dollars. The good news is that Medicare can help cover the cost of a mobility scooter if you meet certain requirements.
In this article, we will discuss the eligibility criteria to receive Medicare coverage for mobility scooters, the process for getting Medicare approval, and the top features you need to consider when buying a mobility scooter.
Key Takeaways
Medicare Part B covers 80% of the cost of a mobility scooter when it is deemed medically necessary by your doctor to help you move around at home.
To receive coverage, your Medicare-enrolled doctor must perform a face-to-face examination and issue a Certificate of Medical Necessity detailing your medical condition and prescribing a scooter model suited to your needs.
When purchased from a Medicare-approved supplier, Medicare generally covers a new mobility scooter once every five years, as long as it’s medically viable and necessary.
How Medicare covers mobility scooters
Medicare covers mobility scooters as Durable Medical Equipment (DME) when certain eligibility requirements are met. But Medicare will only cover a mobility scooter if it’s needed to help you move around at home. Scooters that are primarily used for getting around outdoors may not be approved.
How Medicare Part B covers mobility scooters
Medicare Part B covers the costs of medical equipment, like mobility scooters. For Medicare Part B coverage to apply, the scooter must meet all three of the following conditions:
The scooter must be deemed medically necessary by your health care provider.
It must be prescribed for use inside your home.
It must be purchased or rented from a Medicare-approved supplier.
If your request for a scooter is approved and you’ve met your deductible, Medicare Part B covers 80% of the Medicare-approved cost of the scooter. This leaves you responsible for the remaining 20% of the cost.
If you have a Medicare Supplement (aka Medigap) policy, your out-of-pocket costs will be reduced, or even eliminated, depending on your plan.
How Medicare Advantage plans cover mobility scooters
Medicare Advantage plans must cover at least the same services and medical equipment as Original Medicare. So, like Medicare Part B, Medicare Advantage plans cover mobility scooters.
However, suppliers under Medicare Advantage might vary, and you may need prior authorization before your coverage is approved.
If you have a Medicare Advantage plan, your health insurance premiums, deductible, and coinsurance for mobility scooters will be different from those under Original Medicare. Each Medicare Advantage plan also varies. You can get the exact details of your coverage and out-of-pocket costs from your insurance carrier or your summary of plan benefits.
Will Medicare pay for both a power wheelchair and a mobility scooter?
Medicare Part B will only cover one type of mobility aid for you to use at home. Make sure you use your coverage to get the most appropriate power mobility device to help you get around and improve your quality of life—whether it’s a mobility scooter, manual wheelchair, electric wheelchair, or power wheelchair. Keep in mind, you can choose to purchase an additional aid if you want. You would just be responsible for the full cost.
What is the process for getting Medicare approval for a mobility scooter?
The process for getting a mobility scooter approved by Medicare is as follows:
Meet with your healthcare professional: For Medicare to consider covering a mobility scooter, your doctor must certify that you have a medical condition requiring help moving around your home and undertaking the activities of daily living. Medical approval will usually consist of a face-to-face exam. Your doctor will need to explain why a power scooter is needed, specifically, rather than alternatives like a cane, walker, crutches, or manual wheelchair. The doctor must also confirm you have the physical and mental ability to operate the scooter independently.
Get a prescription: Following the face-to-face exam, your doctor will prepare a detailed medical record and a written prescription. This is when you can ask your doctor about specific scooter models that best fit your needs. The prescription, or Certificate of Medical Necessity (CMN), issued by your doctor and other documents are then forwarded to a Medicare-approved supplier of your choice..
Choose a scooter from a Medicare-approved supplier: Your scooter must come from a Medicare-approved DME supplier for Medicare to cover the costs. Once your doctor provides all the necessary documents, in most cases, the supplier will submit the prior authorization claim to Medicare on your behalf.
At the time of delivery, the supplier will perform an on-site evaluation of your home to confirm the scooter’s maneuverability. Sometimes, a trial period with your scooter may be required to ensure it’s the right fit for your needs.
How often will Medicare cover a mobility scooter?
Medicare may cover a new power scooter once every five years. If your scooter is functioning properly though, and your medical condition has not changed, you may not be eligible for a new one.
On the other hand, if your medical condition changes and you need a different device to support you and help you move around at home, Medicare may cover a replacement earlier.
What should you look for in a motorized scooter?
Knowing that Medicare will only approve coverage for a power scooter about once every five years, you need to make sure that you choose a scooter that suits your medical needs and will last.
Some features you might want to look out for:
Adjustable seats: Adjustable seats comfortably accommodate users of different heights.
Easy maneuverability: Intuitive controls and responsive steering make mobility scooters easy to maneuver.
Weight limit: Scooters have weight capacities, so make sure you select one built for your weight.
Safety features: Built-in safety features such as automatic brakes, lights, and indicators ensure a secure riding experience for us.
Turning radius: A small turning radius makes a scooter more suitable for moving around at home.
How much do mobility scooters cost?
The average cost of a scooter from a Medicare-approved supplier ranges from $899 to $3,999. But prices can vary widely. All-terrain and heavy-duty models can exceed $3,999, especially if they have extra features.
Get personalized Medicare support
Want to learn more about how Medicare covers mobility scooters and other mobility aids?
Get in touch with one of our independent Medicare agents. They’ll help you understand how coverage works and all of your available options. Give us a call at 855-900-2427 or choose a time to talk in advance.