The automatic and premium free part of Medicare is known as “Part A” – which is basically hospitalization insurance and covers most inpatient medical needs, including a mobility scooter if needed while an inpatient.
However, coverage for mobility scooters while an outpatient would come under the category of “Durable Medical Equipment” (DME) regarding Medicare coverage. Such DME coverage is available under Medicare Part B – not under the Hospitalization (Part A) of Medicare. Part B coverage is not automatic and must be enrolled in, plus there is a monthly premium payment required. Also, there is an annual deductible that has to be met ($226 in 2023) before any coverage applies. After the deductible is met, Part B usually will pay for 80% of the cost of DME’s, including scooters. The other 20% must be paid for by the patient. It should be noted that Medicare often will not provide coverage for a purchase of a mobility scooter, but only cover a rental of one – depending on the individual patient’s situation.
There are several eligibility requirements that must all be met regarding the patient for Medicare to provide coverage. These are as follows:
• You have a health condition that makes it extremely hard for you to get around within your own home (Medicare will NOT cover a scooter designed for primarily outside use)
• Coverage can apply if you are living in a relative’s or friend’s home and sometimes in a senior residential facility (but not in a nursing home or similar)
• Medicare will only pay for mobility aids at the level that you need. If your doctor says that a cane is sufficient for your mobility, then Medicare won’t cover a mobility scooter.
• You can’t do daily living activities, such as using the bathroom, bathing, and dressing, even with a walker, cane, or crutches
• You must have adequate upper body strength, which limits what type of controls you can comfortably operate.
• You must have good body balance, which can limit how long you can sit upright. Proper posture is required for operating most mobility scooters.
• You can safely operate the scooter 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 (the scooter must be able to maneuver and fit in all the main areas of your home – particularly the bedroom, bathroom and kitchen)
To get a mobility scooter approved by Medicare, you must first be evaluated by a doctor to confirm medical necessity. This evaluation can also be conducted by an occupational therapist. To go this route, your doctor will have to certify that you need to consult with an occupational therapist and then write a prescription for the scooter.
The documented prescription for a scooter must come from a Medicare approved doctor or occupational therapist after an in-person examination by that doctor or therapist, no more than 45 days in advance of applying for coverage.
Not all DME suppliers are enrolled in Medicare. If you use a DME supplier that isn’t enrolled in Medicare, then Medicare will not pay any claims that the supplier sends them, meaning you will be responsible for 100% of the cost.
Because it is so important to only use a DME provider that is enrolled in Medicare and accepts Medicare assignment, you should use Medicare’s online dedicated DME supplier search tool. This will ensure that any suppliers you find will be covered by Medicare.
This is optional Medicare coverage that is sold and run by private health insurance companies. These policies are regulated by Medicare and must offer at least the same coverage as regular Medicare, including Part B. However, many of these Advantage plans provide more coverage than regular Medicare – including DME coverage. This can mean lower deductibles and cash out of pocket amounts. So, if you have a Medicare Advantage plan, you should check to see what coverage it provides for a mobility scooter.