An electric scooter, otherwise known as a mobility scooter or power-operated vehicle, is a prized aid for anyone who encounters difficulty when walking for a lengthy time period. Similar to a motorized wheelchair, styles can vary. The basic components include a tiller, handlebars and four wheels. Any device that promotes the ability to navigate independently is invaluable to an individual’s quality of life.
Many Medicare recipients face mobility issues due to illness or injury. An electric scooter can be the right solution for many seniors and Medicare recipients under the age of 65 with certain disabilities. Medicare insurance can help cover the costs of an electric scooter if you meet specific criteria.
Medicare Benefits for Durable Medical Equipment
Medicare benefits for both power-operated scooters and manual wheelchairs fall under the category of durable medical equipment (DME). In order to get help paying for the rental or purchase of DME, your doctor must prescribe the equipment. Whether the equipment is a scooter, wheelchair or hospital bed, it needs to be deemed medically necessary by your doctor. The pre-requisites for coverage include a face-to-face exam with your physician and a written prescription from the medical practitioner who renders treatment. If approved, this would be covered under Medicare Part B (Medical Insurance). Additionally, Medicare recipients are eligible for DME coverage only if their doctors and equipment suppliers are participating in Medicare and accept assignment.
Cost of an Electric Scooter with Medicare
There is a distinction between a provider being enrolled in Medicare and participating in Medicare. Enrolled means they have signed up to accept Medicare insurance. Enrollment holds the providers to stringent standards. Assignment means they agree to be paid directly by Medicare, to accept the approved amount, and to bill the Medicare recipient no more than the deductible and coinsurance.
It falls on you to proactively ask your doctors and suppliers if they are participating because if they do not accept assignment, there is no limit to what they can charge. If assignment is accepted, the provider receives the authorized amount directly from Medicare. Medicare recipients accept responsibility for the Part B deductible and will likely be responsible for 20% coinsurance. This applies to individuals who have Original Medicare. If you are enrolled in a Medicare Advantage plan, you will have at least the same Part A and Part B benefits as Original Medicare, but many Medicare Advantage plans offer additional coverage.
Prior Authorization for Power Wheelchairs
Effective September 1, 2018, a program was established that requires prior approval for specific types of power wheelchairs. If you are prescribed one of the 33 wheelchairs on this list, your DME supplier will likely submit a prior authorization request on your behalf. Once eligibility is confirmed, coverage and benefits should stay the same.
Medical Equipment That Meets Your Needs
Health problems can be exacerbated by inactivity, social isolation, and depression. An electric scooter may be the device that gets you or a loved one around their home more easily and out of the house to see friends and engage in their community. An electric scooter fosters independence, societal participation and social interaction. Having said that, there are valid reasons why a doctor may determine this equipment is not a good fit for a patient; for example, vision impairment, mental impediment, inability to stay seated for a long duration or the need for assistance mounting and alighting from a scooter.
Talk to your doctor to find out which options will meet your individual needs. If you are a good candidate for an electric scooter, the next step is to work with your doctor and Medicare to confirm your eligibility for Medicare benefits. If approved, enjoy and stay safe.