Seniors facing mobility issues could benefit from an electric scooter, improving their quality of life. You may wonder if Medicare covers electric scooters and wheelchairs. Mobility aids like scooters and power wheelchairs help people maintain their independence and remain active longer. But which scooter is best? The right choice depends on your individual health needs. This article explores the nuances of Medicare coverage, how to get approved, and safety tips for people considering a scooter.
Understanding Medicare coverage for electric scooters
Medicare will help cover some or all of the cost of an electric scooter, but it depends on a few factors. Coverage and out-of-pocket costs can vary based on the type of Medicare insurance you carry, your medical needs, and your equipment.
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What is durable medical equipment (DME)?
Durable medical equipment (sometimes abbreviated as DME) includes various health-related medical equipment that a person uses daily to participate in normal daily activities. DME could consist of hospital beds, canes, walkers, commodes, CPAP machines, and diabetic supplies. Medicare provides coverage for equipment that helps maintain or improve your ability to move around and function daily. Electric scooters, manual wheelchairs, and power wheelchairs are types of mobility-related DME.
How does Medicare Part B cover electric scooters?
Original Medicare Part B covers electric scooters when you meet specific criteria. Medicare will review your medical records against established guidelines and policies to determine eligibility. Commonly, this is called meeting 'medical necessity.' Part B coverage requires your physician and the DME company to be approved by Medicare. Once you meet the criteria, Medicare Part B covers 80% of the cost after you have met your annual deductible. You are responsible for 20% of the cost. Depending on your situation and if you are expected to recover fully in the short term, Medicare may approve a rental instead of a purchase.
Medigap, Medicare Advantage, and Medicaid
Many seniors supplement their Original Medicare with a Medigap plan or opt for Medicare Advantage. Significant variations exist between plans. The exact benefits will depend on your coverage.
Medigap
Seniors who add a Medigap policy to their Original Medicare may successfully reduce their out-of-pocket costs for an electric scooter. Private insurance companies sell Medigap policies and typically provide additional financial coverage for services rendered under Original Medicare. Depending on your Medigap plan, your portion of the costs may be significantly lower than with Original Medicare alone.
Medicare Advantage
Medicare Advantage policies, sold by private insurance companies, differ from Medigap. People may opt out of Original Medicare and instead enroll in a Medicare Advantage policy. Medical Advantage plans must cover all the same benefits as Original Medicare but usually offer additional benefits. Depending on the policy, you may qualify for more coverage and lower out-of-pocket costs.
Dual eligibility Medicare and Medicaid services
Some people qualify for Medicare and Medicaid services, also known as being dually eligible. In this scenario, you may have additional coverage for mobility aids, lowering your total out-of-pocket costs.
Coverage details can vary by plan and state. Contact your plan representative or insurance broker for more specific coverage details.
Eligibility criteria for Medicare-covered scooters
Completing the eligibility process properly is fundamental; otherwise, you may not get coverage. Begin by making an in-person appointment to visit a physician. Your primary care provider must be Medicare enrolled. When it's time to get the scooter, the DME company supplying the equipment must also be Medicare enrolled and accept assignment. Accepting assignment means that the DME supplier agrees to comply with the Medicare-approved cost of the equipment. The DME company cannot overcharge you if they accept assignment. The Official Medicare website provides lookup directories to help you find Medicare-enrolled physicians and DME companies near you.
Meeting the eligibility criteria for an electric scooter
There are many different types of mobility equipment. If a walker or cane is not an appropriate or safe choice, you may qualify for an electric scooter. An electric scooter and a power wheelchair fall under the CMS category of power mobility devices (PMD). To meet the criteria for an electric scooter, you must first meet some general and specific criteria.
General criteria include:
- You must have mobility limitations that impede your ability to complete regular daily activities within your home.
- A walker or cane is not a sufficient, appropriate, or safe option.
- You cannot use a manual wheelchair due to decreased strength or limitations in your upper extremities (shoulders, arms, and hands).
To meet the specific criteria for an electric scooter, you must meet the above general criteria in addition to the following:
- You can safely transfer to and from the scooter.
- You can safely operate the handlebar system.
- You have enough body strength to maintain proper positioning.
- You meet the weight requirements for the device.
- You do not have any physical or mental limitations that would make using the equipment unsafe.
- Your home environment is safe and there is enough room to safely operate the device.
- A scooter will enhance your ability to perform activities of daily living.
Steps to get a Medicare-covered scooter
Your plan representative and primary care provider can help you through the application process. Typically, they are familiar with the paperwork and know how to proceed. However, it is good to understand the whole process and your responsibilities. You should always double-check that your physician and the DME company are Medicare enrolled because if a mistake is made, insurance companies will typically tell you it is your responsibility to know.
Step-by-step guide from getting a prescription to receiving the scooter:
- Schedule an in-person face-to-face examination with a Medicare-approved doctor to complete a comprehensive health exam, including a limited mobility assessment. Your doctor may refer you to additional occupational or physiotherapy appointments.
- Based on medical need, the doctor will send a written prescription and documentation to the DME supplier.
- The supplier will send the details of the electric scooter model to your doctor. The paperwork is returned to the DME company once your doctor signs off on final approval.
- The DME company will then contact you to arrange a home assessment and delivery of the scooter.
Your insurance company may require a review called a prior authorization. Once you meet the criteria, insurance will typically cover the most basic electric scooter model that can address your needs. They do not usually cover optional upgrades, although that can depend on the type of Medicare coverage. Prior authorization requirements may vary between insurance plans. Some states have regulations regarding prior authorization processes. There is no guarantee that insurance will approve every request. Your physician's office will typically handle the prior authorization process on your behalf.
Types of scooters covered by Medicare
There are many different types of mobility scooters and power chairs. Some vehicles are better suited for indoor use, while others allow indoor and outdoor use. Some are more compact for traveling and have approved batteries for planes and cruises. Speed and charging times can vary, as can customizations. Your physician, occupational therapists, and physiotherapists can make recommendations. Contact your insurance representative or broker for more information about the available models.
Power-operated vehicles (scooters)
Electric scooters have battery-powered motors, a seat, and a handlebar steering system called a tiller. A control allows forward and backward movement. Scooters may come with three or four-wheel options and may be designated for indoor or indoor/outdoor use. Top speeds are generally faster than powerchairs. Scooters are usually easier for traveling. Many models break down easily for transport. They may be less costly than power chairs, and their batteries may charge longer. Medicare will cover replacement batteries that no longer work.
Electric scooters are a good choice for people with enough upper body and core strength to maintain proper positioning, balance, and steering and safely transfer to and from the vehicle.
Exact model coverage can depend on your policy, state, equipment availability, and health needs. Example of electric scooters sometimes covered by Medicare include:
Power wheelchairs vs. electric scooters
Power wheelchairs are different in design and function from mobility scooters. They look more like a traditional seated wheelchair. Powerchairs have a joystick control and can be maneuvered with either your right or left hand. Their motors are battery-powered. Wheels can come in different sizes and configurations. The turning radius is usually smaller than a scooter. Most powerchairs are best suited to indoor use.
Medicare covers power wheelchairs when you meet the criteria and do not qualify for a manual wheelchair or an electric mobility scooter. Replacement batteries are covered by Medicare when necessary.
People with limited upper extremity use may benefit from a power chair, which can be controlled with one hand. People with a history of stroke or muscular disorders may qualify. Many have customizable options, like tremor control, so someone who has Parkinson's, for example, can set the controls to accommodate tremors, and the chair will not move unexpectedly.
A seat elevation option allows users to reach things in cupboards or have a higher view while cooking or performing other daily activities. Medicare may cover seat elevation upgrades for some beneficiaries.
Exact model coverage can depend on your policy, state, equipment availability, and health needs. Example of powerchairs sometimes covered by Medicare include:
What scooters are not covered by Medicare?
Medicare Part B does not cover knee scooters. They are not considered medically necessary because crutches could generally serve the same purpose. However, Medicare Advantage plans and Medicaid services may provide coverage for knee scooters.
Medicare will only cover medically necessary equipment and will not cover optional outdoor scooters.
How much will Medicare pay for an electric scooter?
Your total out-of-pocket costs for an electric scooter depends on:
- The type of scooter and the specific model. Not all models are covered.
- The type of Medicare insurance you carry.
- If you meet the qualifying criteria.
- If you use in-network, approved physicians and DME suppliers.
- If you rent (short-term needs) or purchase (long-term needs).
- If you need extra features or require heavier-duty equipment or seat elevation.
Original Medicare Part B covers 80% of the cost once you satisfy your yearly deductible and meet eligibility criteria. In 2024, the Part B deductible is $240. You are responsible for the remaining 20% of the cost. The exact dollar amount depends on the final price of the specific scooter.
Depending on your needs and the scooter type, renting may be an option. If a rental term spans over the new year, you may need to satisfy the yearly deductible again. For example, if your rental begins in the latter part of 2024 continuing into 2025, you will likely need to pay the 2025 Part B deductible before insurance continues to pay its portion in the new year. However, after renting for 13 months, ownership is transferred to you under Part B.
A Medigap policy may provide additional coverage or reimbursement for the 20% portion of Part B Original Medicare. Your financial responsibility may be reduced partially or totally with a Medigap policy.
Out-of-pocket costs with Medicare Advantage will also depend on the equipment model and your plan benefits. However, Medicare Advantage plans often offer additional coverage for beneficiaries, so it's possible you could reduce or eliminate your financial obligation.
Always contact your insurance representative or insurance broker for more details about your coverage to avoid costly surprises.
Safety tips for using electric scooters
Follow the manufacturer's instructions for proper use and maintenance. Charge and replace batteries per recommendations. Home hazards may influence final decisions for safety reasons. For example, consider the layout of your home, the size of the bathrooms, and turning radiuses. If using a powerchair, your toes may bump into things, causing an injury. The DME company will complete a home assessment to ensure the scooter will fit through your doorways and living areas.
Additional safety tips include:
- Make sure the size is right for you and the weight limitations are correct.
- Take time to learn your vehicle. Understand the controls and functions. Start slow and gain comfort and confidence in your ability to maneuver safely.
- Ask the DME company about daily maintenance.
- Be careful with terrain changes, like carpet to tile or pavement to grass, until you know your system.
- Do not text and drive.
- When using a scooter in public spaces, remember the right of way. Stay to the right side if appropriate and possible, look behind you before stopping suddenly, and use a bell or horn to alert others of your approach.
- Contact your doctor immediately with any new health concerns or changes to your baseline mobility. Unsafe use of a power vehicle could lead to injury and hospitalizations.
Community resources to help seniors pay medicare bills
Medicare beneficiaries needing help paying medical bills may have some options. Various state and community resources, religious centers, and senior community centers may have programs to help alleviate financial burdens for seniors. The official Medicare and U.S. Government websites provide information and links to assistance programs for seniors. You may need to meet income or other requirements to qualify, and programs can vary by state.
Medicare savings programs assisting with Part B costs include, but are not limited to:
- Qualified Medicare Beneficiary Program
- Specified Low-Income Medicare Beneficiary Program
- Qualifying Individual Program
The Medicare Rights Center is a national nonprofit organization that helps people understand their rights and benefits. Its website provides a wealth of information and resources for people enrolled in Medicare or planning to enroll.
If you are a Medicare beneficiary and struggle with everyday tasks because of limited mobility, an electric scooter or powerchair might improve your independence and quality of life, allowing you to participate in things you enjoy and stay active longer. Understanding health benefits can be challenging, but you may qualify for coverage. Contact your doctor to take the first step.
FAQ
Does Medicare cover scooters for seniors?
Medicare covers scooters and power chairs for seniors under the Part B benefit. They do not cover knee scooters as these are not considered medically necessary. You will need a prescription from your doctor, and both your physician and the DME supplier must be Medicare-approved to get coverage.
Which mobility scooter is best?
The best mobility scooter fits your needs and is safe to use. For manual wheelchairs, you must have enough upper body strength to use them. For power scooters and wheelchairs, you must be strong enough to sit up in the chair and use the controls. Your medical provider can help you decide which scooter is best for you.
Can I get a scooter for outdoor use covered by Medicare?
No, Medicare will not cover a recreational outdoor scooter. You must have a qualifying medical need and require the scooter within your home for everyday living and improved mobility. Medicare covers the most basic scooter to fit your needs and may require prior authorization. A scooter may be approved when a cane or manual wheelchair is not a safe option.
What happens if my scooter needs repairs?
Medicare covers repairs and maintenance when a professional is needed. You may have a coinsurance on repair costs. Repairs should be covered under the rental agreement if you rent equipment. Medigap and Medicare Advantage may have additional benefits. Contact your insurance representative for more information.
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If you suffer from mobility limitations, an electric scooter or power wheelchair may improve your quality of life. The first step to approval is scheduling a face-to-face appointment with your doctor.
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Medicare requires your physician and the DME supplier to be Medicare-approved in order to qualify for coverage.
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Coverage for electric mobility scooters can differ depending on your policy. Out-of-pocket costs can vary between Original Medicare, Medigap, and Medicare Advantage insurance policies.
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Medicare Part B covers electric scooters and power chairs when you meet the criteria. You must have a qualifying health condition and difficulty doing daily activities at home.
10 resources
- Medicare.gov. Wheelchairs & scooters.
- Medicare.gov. Search for medical equipment and suppliers.
- Medicare.gov. Get help with costs.
- USA.gov. How to get help with medical bills.
- CMS.gov. Power mobility devices.
- CMS.gov. Seat elevation systems as an accessory to power wheelchairs.
- CMS.gov. 2024 Medicare Parts A & B premiums and deductibles.
- Medicare.gov. Durable medical equipment coverage.
- Medicareinteractive.org. Coverage of power wheelchairs and scooters.
- Marc's Mobility. Should you get a mobility scooter or a powerchair? What's the difference?
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