As we get older, problems with mobility are frustratingly common. That often means that we need help using a wheelchair or a scooter to get around. These pieces of medical equipment can be very expensive, however, which is challenging for those who are no longer working.
If you have Medicare coverage you may have questions like “Does Medicare cover wheelchairs?” or “Do I qualify for a free mobility scooter?” This is especially true if you’ve seen certain advertisements that promote Medicare coverage for these devices.
This guide will answer the common questions around Medicare and wheelchairs or scooters. Of course, if you have additional questions, you can always contact us directly!
If your doctor finds that you need a manual wheelchair to aid with your mobility, they will prescribe one for you. You can take this prescription to a durable medical equipment provider (DME) to get your wheelchair.
Medicare Part B provides coverage for wheelchairs if the DME accepts assignment from Medicare and is properly enrolled.
You also need to meet the following requirements:
If you meet the criteria, you’ll pay your Part B deductible (if it hasn’t already been met) and then 20% of the Medicare approved cost of the wheelchair. Medicare will pay the rest. You may have to rent the wheelchair initially, and buy it after a period of time.
If you have Medicare Advantage instead of Original Medicare, you will have at least as much coverage for a wheelchair as Part B provides. Since wheelchairs are covered by Part A and Part B, you will also be able to get coverage under Medicare Advantage. It’s important that you talk to your insurance provider to find out what the requirements are to get a wheelchair covered by Medicare Advantage.
Most people feel that motorized wheelchairs, better known as scooters, are easier to use and get around in than a manual wheelchair. However, they are also more expensive, so Medicare has some extra requirements before coverage applies.
If you’re asking, “How do I get Medicare to pay for a scooter,” you’re not alone. Many older folks prefer a scooter over a manual wheelchair, especially since a wheelchair requires so much upper body strength to operate.
To qualify for a scooter, you must first meet the initial wheelchair requirements listed in the previous section. In addition, you must be:
Many power wheelchairs or scooters require preauthorization from Medicare. This involves sending medical documentation that shows the scooter is medically necessary. Your DME can request the preauthorization for you, using your prescription and other information about the device.
If Medicare receives incomplete information, or finds that you don’t medically require the scooter, your preauthorization may be denied. You can call them directly at the number on the notice to get more information.
If you have a Medicare Advantage plan, you will have at least as much coverage as Original Medicare described above. However, it’s possible that you’ll have additional coverage, such as more options or lower out-of-pocket costs. Contact your insurer directly for more information.
Without insurance coverage, you’ll find that mobility scooters range in price from $800 to $4,000. The more expensive ones are meant for heavy-duty use and support a higher weight limit. Cheaper scooters are for casual use and support a more typical weight range. Battery life is another factor in the price of a scooter. The less expensive ones might last only a few hours, with pricier models made to be driven all day.
If a scooter is medically necessary for you, Original Medicare will cover 80% of the Medicare-approved cost after your deductible is met for the year. You’ll be left with 20%. Keep in mind that the Medicare-approved cost is often much lower than the consumer price tag.
Perhaps you only need a scooter temporarily, while recovering from an injury or surgery. In that case you can keep your costs lower by renting the scooter. You’ll pay 20% of the Medicare-approved rental costs after your deductible.
If you have Medicare Advantage, your costs will vary depending on your plan. You may pay a percentage of the price or a flat copayment.
Can you qualify for a free medical scooter? If you’re a lower-income senior who is enrolled in Medicaid as well as Medicare, then Medicaid may cover your portion of the costs. This would allow you to get a free scooter, but only if the DME participates in both Medicare and Medicaid.
Qualifying veterans may also be able to get a free scooter if it’s medically necessary and a VA clinician verifies your eligibility. It may take a few months to be approved and get the scooter, but the VA can cover up to 100% of the cost.
Finally, there are some charities that help seniors afford mobility equipment. They may be able to help you pay for your portion of the Medicare-covered wheelchair or scooter. Some examples of these charities include the American Outreach Foundation, Friends of Disabled Adults and Children, and others.
If you’re struggling with mobility, it can be a relief to know that Medicare will cover medically-necessary wheelchairs and scooters. Of course, the details will depend on your specific needs and the type of Medicare plan you have.
If you have additional questions about Medicare and wheelchairs or scooters, we’re here to help. Contact us to learn more.