If you or a loved one is finding it hard to get around at home, youâ€™re in good company. At least 24 percent of Medicare recipients over 65 report needing and using a mobility device, such as a mobilized scooter.
If you are enrolled in Medicare and meet specific requirements, the partial cost of the purchase or rental of a mobility scooter can be covered by Medicare Part B.
What parts of Medicare cover mobility scooters?
Medicare is made up of parts A, B, C, D, and Medigap.
- Medicare Part A is part of original Medicare. It covers inpatient hospital services, hospice care, nursing facility care, and home health care services.
- Medicare Part B is also part of original Medicare. It covers medically necessary services and supplies. It also covers preventive care.
- Medicare Part C is also called Medicare Advantage. Part C is purchased from private insurers. It covers everything parts A and B do, but typically includes additional coverage for prescription drugs, dental, hearing, and vision. Part C plans vary in terms of what they cover and cost.
- Medicare Part D is prescription drug coverage. There are multiple plans available from private insurance companies. Plans provide a list of covered medications and how much they cost, known as a formulary.
- Medigap (Medicare Supplemental insurance) is supplemental insurance sold by private insurers. Medigap helps pay for some of the out-of-pocket costs from parts A and B, such as deductibles, copays, and coinsurance.
Medicare Part B coverage for scooters
Medicare Part B covers the partial cost or rental fee for power mobility devices (PMDs), such as mobilized scooters, and other types of durable medical equipment (DME), including manual wheelchairs.
Part B pays for 80 percent of the Medicare-approved portion of the cost of a scooter, after you meet your annual Part B deductible.
Medicare Part C coverage for scooters
Medicare Part C plans also covers DME. Some plans also cover motorized wheelchairs. The level of DME coverage you get with a Part C plan can vary. Some plans offer significant discounts, but others donâ€™t. Itâ€™s important to check your plan to determine what you can expect to pay out of your pocket for a scooter.
Medigap coverage for scooters
Medigap plans may also help with coverage of out-of-pocket costs, such as your Medicare Part B deductible. Individual plans vary, so be sure to check first.
For the cost of your scooter to be covered, you must get it from a Medicare- approved supplier who accepts assignment. A list of Medicare-approved suppliers can be found here.
Am I eligible to get help paying for a scooter?
You must be enrolled in original Medicare and meet specific PMD eligibility requirements before Medicare will help pay for your scooter.
Scooters are only approved by Medicare if you need a scooter to ambulate in your home. Medicare wonâ€™t pay for a power wheelchair or scooter that is only needed for outside activities.
Getting a scooter prescription
Medicare requires a face-to-face meeting with your doctor. Make sure your doctor accepts Medicare.
At the visit, your doctor will evaluate your medical condition and prescribe a DME for you, if needed. Your doctorâ€™s prescription is referred to as a seven- element order, which tells Medicare that a scooter is medically necessary.
Your doctor will submit the seven-element order to Medicare for approval.
Criteria you must meet
It should say that a scooter is medically necessary for use in your home, because you have limited mobility and meet all of the following criteria:
- you have a health condition that makes it extremely hard for you to get around within your own home
- you canâ€™t do daily living activities, such as using the bathroom, bathing, and dressing, even with a walker, cane, or crutches
- you can safely operate a mobilized device and are strong enough to sit up on it and use its controls
- you are able to get on and off the scooter safely: if not, you must always have someone with you who can assist you and ensure your safety
- your home can accommodate scooter use: for example, a scooter will fit in your bathroom, through your doors, and in hallways
You must go to a DME supplier who accepts Medicare. The approved seven-element order must be sent to your supplier within 45 days of your face-to-face doctorâ€™s visit.
Costs and reimbursement
After you pay your Part B deductible of $198 in 2020, Medicare will cover 80 percent of the cost to rent or buy a scooter. The remaining 20 percent is your responsibility, although it may be covered by some Part C or Medigap plans.
To keep costs down and make sure that Medicare pays its part for your scooter, you must use a Medicare-approved supplier who accepts assignment. If you donâ€™t, the supplier may charge you a much higher amount, which you will be responsible for.
Ask about Medicare participation before you commit to purchasing a scooter.
A Medicare-approved supplier will send the bill for your scooter directly to Medicare. However, you may be required to pay the entire cost upfront and wait for Medicare to reimburse you for 80 percent of the scooterâ€™s cost.
If you decide to rent a scooter, Medicare will make monthly payments on your behalf for as long as the scooter is medically necessary. The supplier should come to your home to pick the scooter up when the rental period ends.
Here is a list of steps to help you get your scooter covered and in your home:
- Apply for and enroll in original Medicare (parts A and B).
- Make an appointment with a Medicare-approved doctor for a face-to-face visit to confirm your eligibility for a scooter.
- Have your doctor send a written order to Medicare indicating your eligibility and need for a scooter.
- Decide which type of scooter you need and if youâ€™d rather rent or buy.
- Look for a Medicare-approved DME supplier who accepts assignment here.
- If you cannot afford the cost of the scooter, call your local Medicare or Medicaid office to determine your eligibility for Medicare savings programs which may help.
Many Medicare recipients have trouble getting around at home. When a cane, crutches, or walker is not enough, a mobility scooter may help.
Medicare Part B covers 80 percent of the cost of mobility scooters, as long as you meet some specific requirements.
Your doctor will determine your eligibility for a scooter.
You must use a Medicare-approved doctor and a Medicare-approved supplier that accept assignment to have your scooter approved and covered by Medicare.
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