A mobility scooter is an advanced vehicle that individuals with certain disabilities use to improve their mobility. It provides individuals that cannot walk without difficulty, or that cannot walk at all without assistance with the means to improve their independence, and likely their confidence. People often find that they are able to participate in activities and perform some tasks that were either difficult or impossible to engage in before getting their scooter.
Mobility scooters in the past were difficult to maneuver inside or outside the home. The improved maneuverability, new styles and models, more comfortable seating, and modern technology help to improve the lives of many people.
One thing that has not changed is the fact that they are expensive. The cost of replacing the battery in a battery-powered scooter may be as much as 30 percent of the cost of the scooter.
Does Medicare cover scooters? Do Medicare Advantage plans help to pay for them? Is there Medicaid coverage for scooters? Will my VA benefits help me to get a scooter? What do I need to know about private insurance and mobility scooters? How do I get a mobility scooter for free ?
These are questions that people with mobility issues often ask when they feel that they need a scooter. Exploring these questions and issues related to mobility scooters and how to pay for them can provide information about getting the cost of a mobility scooter covered by insurance with little or no cost to the individual.
The short answer to this question is “Yes.” Do not get excited just yet because there are strict conditions and an application process required before Medicare considers covering a mobility scooter. It is important to understand that Medicare coverage for mobility scooters is done on a case-by-case basis. So, just because you are on Medicare does not mean that you are automatically eligible for a Medicare-covered scooter.
First, you must be a Medicare beneficiary that has original Medicare. Durable medical equipment (DME), including scooters, is covered under Part B. Medicare covers 80 percent of the cost of mobility scooters once approved for an eligible individual. You pay the other 20 percent of the cost.
Your doctor must indicate that you need a mobility scooter for in-home use. Medicare Part B does not cover any costs related to mobility scooters for use strictly outside the home.
Medicare considers covering a mobility scooter only if the beneficiary meets several additional conditions, which include:
You must have a face-to-face appointment with your physician that is enrolled in Medicare. The appointment for the purpose of being approved for a mobility scooter involves more than your usual 15-minute doctor’s appointment.
The application process requires that the doctor write a prescription called a 7-element order, and to then send the written prescription, along with supporting documentation to the supplier. Medicare indicates that the supplier creates a detailed product description of the PMD and sends it to the provider. The provider then reviews the detailed product description, signs and dates it and returns it to the supplier.
It is important that the doctor answers the required questions about the patient when writing the 7-element order. The doctor must also be very specific in answering the required questions, and must include “a detailed, narrative note in the patient’s medical record.”
It is important to know what mobility scooters are covered by Medicare before you make a purchase. If you purchase a scooter in advance and Medicare does not cover that particular scooter, you will not receive reimbursement for it.
Medicare will cover an electric scooter, referred to as a “power-operated” scooter. Medicare will not cover a knee scooter.
Medicare recently launched an improved supplier directory that helps individuals find suppliers for scooters and other types of covered equipment and supplies. Go to the site page and enter your zip code. There is an optional “equipment” box. Click inside the box and you will get a drop-down list.
Click on the last item on the drop-down, which is “Browse equipment and supplies A-Z.” A list pops up on the right side of your page. Scroll down and click on “scooters.” You will get a list of suppliers in your zip code.
There is a required on-site evaluation of the patient’s home performed before or at the time of the scooter delivery. A written report accompanies the evaluation.
The person conducting the evaluation confirms that the patient can maneuver their scooter inside the home, considering the physical layout, the doorways thresholds and width, and the surfaces.
The supplier sends the claim for the cost of your mobility scooter to Medicare. Some suppliers may require that you pay the entire amount of a scooter upfront and wait for reimbursement.
Once you pay your Part B deductible, you may be eligible to receive reimbursement for your portion of the cost of your mobility scooter.
Patients do not provide evaluation forms. Your doctor will provide the proper forms and documentation to your supplier.
The supplier and provider complete their required forms and follow Medicare procedures that are required for your scooter coverage. You can check with your doctor or with Medicare to find out the status of your evaluation and mobility scooter approval.
Medicare does cover mobility scooter rentals for eligible individuals. Some people prefer scooter rental, especially if they do not permanently require a scooter.
Medicare makes monthly payments on your behalf while you need a mobility scooter. Once the rental period ends, the supplier will pick up the scooter at your home.
Medicaid does cover mobility scooters on a case-by-case basis. Some aspects of the coverage are different under Medicaid, compared to Medicare. One fact is that Medicaid is administered by the individual states. Therefore, there may be some variation in the process of receiving coverage.
A 2017 letter to state Medicaid directors explained that “medical supplies, equipment and appliances are a mandatory benefit” and that the act “does not specify a list of medical equipment and appliances that are allowable in the Medicaid program.” The individual states, under Medicaid rules, states “are prohibited from having absolute exclusions of coverage on medical equipment, supplies, or appliances.”
There is still a comprehensive application process to determine whether a patient qualifies for Medicaid coverage for a mobility scooter. The physician, supplier and provider follow the procedures required for coverage in the specific state.
Many states use the Medicare payment rates when they cover mobility scooters. Many Medicaid recipients do not pay any costs for their medical coverage. Medicaid recipients cannot, however, just select a scooter that they want and hand over their Medicaid card for coverage. The provider, supplier, and physician must all accept Medicaid and be properly enrolled in the state program.
Are you a senior that receives Medicaid QMB? You may be able to get your scooter without cost if you do, since you do not pay deductibles, co-pays or other costs. Make sure that you give the physician, supplier and provider your Medicare card and your “Medicaid QMB” card.
You may qualify for this program if you are on Medicare and are income-eligible. The program, called Medicare Qualified Beneficiary, is administered through Medicaid. Many people that receive Medicare also receive Medicaid QMB benefits, which cover premiums, deductibles, and co-pays.
Contact Medicare to learn more about the program and you may be able to receive extra coverage, meaning that Medicaid pays for the costs of your scooter that is not covered by Medicare. The program does not cover benefits such as dental, vision, and hearing aid costs.
There is no quick answer to whether VA benefits will cover a mobility scooter. The decision is made on a case-by-case basis, the same as with Medicare and Medicaid coverage for scooters. Each veteran is entitled to an evaluation to see if they qualify for coverage of a scooter or other power mobility device.
A notice sent to physicians and clinicians established protocol related to the criteria for potentially qualifying for a scooter or other DME. It also stated that a motorized wheeled mobility device is not to be prescribed solely for recreational use.
A veteran must undergo a comprehensive evaluation to determine their eligibility for receiving a scooter that is covered by the VA. The physician or other person performing the evaluation must take into account the medical diagnoses of the patient, their functional abilities, their limitations, prognosis, goals, and ambitions.
The evaluation for a free scooter will include an assessment of the “musculoskeletal, neuromuscular, pulmonary, and cardiovascular capacities and response, effort, quality,” and the veteran’s overall function. The Veteran’s Administration explains that power mobility is indicated if the veteran demonstrates a clear functional need for the scooter, which cannot be met by traditional medical or rehabilitation efforts or interventions.
Do you have private insurance? You may qualify for coverage of your mobility scooter through your insurance plan . It is imperative that an individual does not purchase a mobility scooter first and then expect their insurance company to reimburse them for the scooter.
Individual insurance companies and the various plans are often different from one insurance provider to the next provider. Read your insurance plan for specific information on coverage of a mobility scooter. Insurance plans are sometimes written in complicated terms, so if you are not sure if you have coverage for a mobility scooter, or if you meet eligibility for one, contact your provider.
If you purchase a mobility scooter upfront, you may not receive reimbursement. Follow the instructions in your specific plan, and you may discover that you are able to get a scooter at little to no cost to you.
Mobility scooters may provide a great deal of independence for individuals, compared to their current level of mobility. Medicare, Medicaid, the VA, or private insurance may cover part or all of the cost of a mobility scooter that is for in-home use.
Patients must comply with an evaluation that is performed by a qualified physician or therapist, as determined by the insurance provider. The physician, the supplier, and provider of the mobility scooter must meet program requirements and complete necessary forms and evaluation documents. Failure to meet any of the procedures required for coverage of a scooter may cause delay in the person receiving the scooter.
If you believe that you meet the criteria to qualify for a mobility scooter, talk to your physician or insurance representative to learn how to get started on your way to a new lifestyle of independence and greater mobility today.
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