Mobility scooters have the ability to make difficult tasks possible for many seniors. However, when the once simple task of walking has become debilitating, and you may be unsure if you can afford a solution.
Fortunately, Medicare can provide coverage for Durable Medical Equipment (DME) if you meet some specific requirements. Mobility scooters, being a particularly expensive form of durable medical equipment, have a few extra steps for getting them covered.
KD Smart Chair does not accept insurance, Medicare or Medicaid.
Follow the steps below to improve your chances of getting your mobility scooter covered by Medicare.
Medicare Guidelines for DME
Coverage for scooters falls under Medicare Part B, which covers outpatient expenses. Assuming you have enrolled in Part B, your first step will be to get your mobility scooter prescribed by a doctor that accepts Medicare.
Your doctor will meet with you face to face. He or she will be assessing that you have a health condition which makes a mobility scooter medically necessary. Medicare also only covers durable medical equipment if it will be used in the patient’s personal home. This means if you live in a nursing home or are staying in a skilled nursing facility, Medicare Part B will not cover your scooter.
Your doctor must also document that you are unable to perform Mobility Related Activities of Daily Living (MRADLs) in your own home without the help of the scooter. This means that other mobility devices such as a cane or walker are not considered sufficient by your doctor to improve your mobility.
Mobility Related Activities of Daily Living (MRADL)
MRADL activities include those that are related to mobility such as feeding yourself, bathing, using the restroom, or transitioning from one room to another in your home.
Your scooter would be considered reasonable and necessary if you have a mobility limitation restricting you from being able to perform MRADLs. For example, if you have a risk of falling while trying to attempt the activity, this would be considered a mobility limitation.
Your limitation could also be that you are unable to perform the activity in a timely manner. An example of this would be if you are unable to transition from your bedroom to your kitchen to feed yourself, you’d have a mobility limitation.
Another requirement is that you must be able and willing to use the scooter safely within your home.
Specific Qualifications for Mobility Scooters
Medicare will always try to pay for the least expensive option when it comes to durable medical equipment. The more expensive the equipment, the more hoops you’ll have to jump through to get it covered. Scooters, of course, are one of the more expensive options. So, if you have the upper body strength and ability to use a manual wheelchair, Medicare may not approve you for a power scooter.
In addition to meeting the above requirements of MRADL, you must also get your scooter through a DME supplier that has an Assistive Technology Professional (ATP) who is certified by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)
This person specializes in seating and wheeled mobility devices. The supplier’s ATP is familiar with the rules and guidelines of mobility scooters and will be able to select an option that suits you and that you can qualify for.
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.
The Costs for Your Mobility Scooter
Medicare normally pays 80% of your Part B bills, while you pay 20%. If you go through a supplier that accepts Medicare’s assigned rate, you will pay the other 20% of the bill.
If you use a supplier that doesn’t accept Medicare assignment, that supplier is allowed to charge you a higher price called an excess charge. Medicare will still only pay 80% of their approved price. Then you will be left to pay the original 20% plus the excess charge that the supplier charges.
Many people with Medicare have Medigap plans to help them pay for these gaps. For instance, if you had a standard Medigap Plan G, your 20% or that bill would be covered in full. Plan G also covers excess charges, so you would have no out-of-pocket costs for your scooter.
Some individuals choose to enroll in a Medicare Advantage plan instead of Original Medicare. In this scenario, the Medicare Advantage plan will review the evidence to determine medical necessity. If the scooter is approved, your cost-sharing will be determined by the plan.
A Medicare broker can assist you in evaluating which Medigap plans might be the best fit or your personal needs and budget.
Yes, there are many steps you must take to ensure that your mobility scooter is covered by Medicare. However, if a beneficiary meets the medical necessity requirements, then Medicare can and will provide coverage for equipment that will help improve their activities of daily living.
Danielle Roberts is the co-founder of Boomer Benefits, where her team helps Baby Boomers navigate their new Medicare benefits.