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How to get a free scooter from Medicare?

Published in Medicare Mobility Equipment 4 mins read

While Medicare does not provide scooters entirely "free," it can significantly cover the cost if you meet specific medical criteria. Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters) and wheelchairs as durable medical equipment (DME) when deemed medically necessary for use in your home.

Medicare Coverage for Scooters

Medicare Part B helps cover the cost of medically necessary durable medical equipment (DME), which includes power-operated vehicles like scooters. For Medicare to cover a scooter, specific conditions must be met:

  • Medical Necessity: Your doctor must submit a written order stating that you have a medical need for a scooter. This means your health condition causes significant impairment, making it difficult or impossible to move around in your home without the device.
  • Home Use: The scooter must be primarily for use within your home. Medicare's coverage is generally focused on assisting with activities of daily living within your living space, not for outdoor or recreational use.
  • In-Person Examination: Your doctor must conduct an in-person examination to assess your mobility limitations and determine if a scooter is the most appropriate equipment for your needs.

What is Durable Medical Equipment (DME)?

Durable Medical Equipment (DME) includes equipment that:

  • Is durable (can withstand repeated use).
  • Is used for a medical reason.
  • Is not usually useful to someone who isn't sick or injured.
  • Is used in your home.
  • Has an expected lifetime of at least 3 years.

Eligibility Requirements for a Medicare-Covered Scooter

To be eligible for Medicare coverage of a scooter, you generally must meet the following criteria:

  • You have a medical condition that significantly impairs your ability to move within your home.
  • You are unable to perform activities of daily living (like bathing, dressing, or using the restroom) in your home without a scooter.
  • You can safely operate the scooter, or you have a caregiver who can safely operate it for you.
  • Other mobility aids, such as a cane or walker, are insufficient to meet your mobility needs.
  • Your doctor and the scooter supplier must be enrolled in Medicare.

Steps to Obtain a Scooter Through Medicare

Follow these steps to navigate the process of getting a scooter covered by Medicare:

  1. Consult Your Doctor: Schedule an appointment with the doctor treating your condition. Discuss your mobility challenges and explain why you believe a scooter is necessary for your independence within your home. Your doctor will assess your medical need.
  2. Obtain a Written Order: If your doctor determines a scooter is medically necessary, they will provide a written order (prescription). This order must explicitly state your medical condition, why a scooter is needed, and confirm its use in your home.
  3. Choose a Medicare-Approved Supplier: Select a DME supplier that is enrolled in Medicare and accepts assignment. Accepting assignment means the supplier agrees to accept the Medicare-approved amount as full payment for the covered service or item. You can find approved suppliers through Medicare's website.
  4. Supplier Submits Claim: The DME supplier will work with your doctor to gather all necessary documentation and submit the claim to Medicare on your behalf.
  5. Delivery and Training: Once approved, the supplier will deliver the scooter and provide instructions on its safe operation and maintenance.

Understanding the Costs

While Medicare Part B covers scooters, it typically pays 80% of the Medicare-approved amount after you've met your Part B deductible for the year. This means you are generally responsible for the remaining 20% coinsurance.

Cost Component Description
Part B Deductible You must pay your annual Part B deductible before Medicare starts paying its share.
20% Coinsurance After the deductible, Medicare pays 80% of the Medicare-approved amount, and you pay 20%.
Medigap/Medicare Advantage If you have a Medigap (Medicare Supplement Insurance) policy or a Medicare Advantage Plan (Part C), it may help cover some or all of the 20% coinsurance. Check your plan's benefits.

Medicare may also offer the option to rent a scooter for a period before deciding to purchase it, especially if your need is expected to be temporary. The decision to rent or purchase often depends on your specific medical condition and expected long-term needs.

Important Considerations

  • Rental vs. Purchase: Medicare may cover the rental or purchase of a scooter. Your doctor's order and the specific medical necessity will often guide this decision.
  • Prior Authorization: For certain types of DME, including some scooters, Medicare may require prior authorization before it will cover the cost. Your supplier will typically handle this process.
  • Maintaining Eligibility: Ensure that the scooter continues to be used for its intended medical purpose in your home.
  • Documentation is Key: Accurate and comprehensive documentation from your doctor about your medical need is crucial for Medicare approval.

By understanding these guidelines and working closely with your doctor and a Medicare-approved supplier, you can navigate the process of getting a scooter covered by Medicare.