Mobility is more than just getting from one place to another. For seniors and individuals with disabilities, it is about independence, freedom, and quality of life. Being able to move freely can significantly impact daily living, mental health, and overall well-being.
This article aims to explore a common question among our community members… does Medicare pay for a mobility scooter?
We’ll provide you with valuable information on Medicare coverage, the eligibility criteria, the process of obtaining a mobility scooter, and alternative funding sources.
We will also discuss the conditions and requirements that need to be met for Medicare to cover mobility scooters, including the necessity of the equipment due to a medical condition, the documentation required from a doctor, and the use of the scooter primarily at home.
Whether you are an elderly person, a disabled individual, or a caregiver, this guide will offer actionable insights to help you or your loved ones regain mobility and independence.
Understanding Medicare Coverage
Medicare is a federal health insurance program primarily for people aged 65 and older, but it’s also available to certain younger individuals with disabilities. Understanding the different parts of Medicare is crucial when figuring out what it covers regarding mobility aids.
The Centers for Medicare and Medicaid Services (CMS) play a significant role in making decisions related to medical equipment and services for individuals qualifying for Medicare.
Medicare Part A and Part B
Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. It’s generally not concerned with outpatient medical supplies like mobility scooters.
Medicare Part B, on the other hand, is more relevant to our discussion. It covers outpatient care, preventive services, ambulance services, and durable medical equipment (DME), which includes mobility scooters. Medicare Part B also covers other mobility aids like manual wheelchairs, power wheelchairs, and electric scooters.
To have a mobility scooter covered under Part B, certain conditions must be met.
Medicare Part C and Part D
Medicare Part C, or Medicare Advantage, is an alternative to Original Medicare (Parts A and B) offered by private companies approved by Medicare. These plans must cover everything that Original Medicare covers and may offer additional benefits. Some Medicare Advantage plans, also known as Medicare Advantage Plans, may offer additional benefits for mobility aids.
Some Medicare Advantage plans include extra coverage for mobility aids, so it’s worth checking the specifics of your plan.
Medicare Part D covers prescription drugs and doesn’t directly relate to mobility scooters. However, understanding the full scope of your Medicare benefits can help you make more informed decisions about your healthcare needs
Durable Medical Equipment (DME)
Mobility scooters fall under the category of Durable Medical Equipment (DME). To qualify as DME, the equipment must be durable, used for a medical reason, not typically useful to someone who isn’t sick or injured, and used in your home. The medical need for the equipment must be documented in the individual's medical records by their doctor.
Medicare Part B covers 80% of the Medicare-approved amount for DME, leaving you responsible for the remaining 20% and potentially any associated deductibles.
Eligibility for a Mobility Scooter
Getting Medicare to cover a mobility scooter is not automatic. Several criteria must be met to ensure that the scooter is medically necessary and the best option for your condition. Both the prescriber and the DME supplier must accept Medicare for the mobility scooter to be covered.
Medical Necessity
First and foremost, a mobility scooter must be deemed medically necessary. A power scooter is one of the types of mobility aids that may be deemed medically necessary. This means that it must be required to address a specific medical condition or disability that hampers your ability to perform daily activities.
Your healthcare provider will need to document that you have limited mobility and that a scooter is necessary for you to function independently within your home.
Face-to-Face Examination
A face-to-face examination with your doctor is required to determine your need for a mobility scooter. During this appointment, your doctor will assess your mobility limitations and discuss other mobility aids you may have tried, such as canes or walkers. During the examination, the doctor may also evaluate the need for other mobility aids like power wheelchairs.
The goal is to establish that a mobility scooter is the best and most effective solution for your needs.
Written Order from a Doctor
After the face-to-face examination, your doctor must provide a written order, often referred to as a prescription, for the mobility scooter. This written order may include other mobility devices like power wheelchairs.
This order must include specific information, such as your diagnosis, the type of scooter recommended, and how it will benefit you in your daily activities.
This documentation is crucial for Medicare approval.
Alternative Funding Sources
Not everyone will meet Medicare’s criteria for a mobility scooter, and others may find the out-of-pocket costs challenging even with coverage. Fortunately, there are alternative funding sources available. Medicare Advantage Plans may also offer additional benefits for mobility aids.
Financing
Many suppliers offer financing plans to spread out the cost of a mobility scooter. As an example, here at Everlasting Mobility, we’ve teamed up with financial institutes to provide you with secure financing if you require it. But always do your due diligence… be sure to thoroughly review the terms and conditions before committing to a financing plan.
Private Insurance
If you have private health insurance, check your policy for coverage options related to mobility aids. Some private insurers offer partial or full coverage for mobility scooters.
Medicaid
Medicaid, a state and federal program that provides health coverage for low-income individuals, often covers mobility scooters. Eligibility and coverage vary by state, so it’s important to check your state’s specific Medicaid guidelines.
Veterans Affairs (VA)
If you’re a veteran, you may qualify for a mobility scooter through the Department of Veterans Affairs (VA). The VA offers a range of benefits for veterans, and mobility aids are often included.
Contact your local VA office for more information on eligibility and the application process.
Nonprofit Organizations
Several nonprofit organizations provide financial assistance or discounted mobility scooters to those in need. Organizations like the Mobility Equipment Recyclers or the Free Wheelchair Mission can be invaluable resources when seeking alternative funding options.
Conclusion
Mobility is crucial for maintaining independence and quality of life, especially for seniors and individuals with disabilities. While Medicare can cover mobility scooters, understanding the eligibility criteria and the process is essential for securing this benefit.
Remember, alternative funding sources are available if you don’t meet Medicare’s requirements.
Regaining your mobility and freedom is possible, and taking the first step is easier than you think. Explore your options, consult with your healthcare provider, and take advantage of the resources available to you.
If you're feeling confused by all the electric wheelchair options out there, don't worry… you're not alone!
Just give us a shout!
Our team of Mobility Experts is here to help.
Got questions about a specific chair? Not sure which one suits your needs best?
Call us now at800-498-2560 or shoot us an email atsupport@everlastingmobility.com.
We're always happy to assist!
And if you want more information before making a decision, please read our articles “How Much Is Mobility Scooter? Pricing and Options Explained” and “6 Most Comfortable Wheelchairs [2024]”.
Need Financial Help?
Are you or a loved one in need of a reliable and comfortable wheelchair? Look no further! Our mobility experts are here to help seniors and their families find the perfect fit.
Call us at800-498-2560 for personalized assistance.
Flexible Financing Options to Suit Your Needs
We understand that affordability is key, which is why we offer a range of flexible financing options to make getting a new wheelchair stress-free:
-
Klarna Financing: Take advantage of budget-friendly installment plans through our partnership with a leading European bank.
-
Shop Pay: Manage your payments with ease and clarity, thanks to our collaboration with Affirm.
-
PayTomorrow: Enjoy a smooth application process, transparent pricing, and auto-pay features—all while safeguarding your credit score.
Don't wait—contact us today at800-498-2560 and get your new wheelchair without breaking the bank!
