Are Power Scooters Covered By Medicare
Scooters are covered as DME if they are prescribed for use in your home by a doctor. Medicare will also help pay for a power wheelchair if it is deemed medically necessary and you meet certain conditions.
A power wheelchair is essentially an electric wheelchair and is meant for people who dont have the strength or mobility to safely use a manual wheelchair or steer a scooter. In addition to a written prescription, you also have to go through a face-to-face examination before Medicare will help pay for a power wheelchair.
Medicare will only help pay for a power wheelchair if you:
- Significantly struggle to move around your home
- Cant safely use a cane or walker
- Cant safely use a wheelchair
- Dont have the strength to operate or steer a scooter
- Go through a face-to-face exam with your doctor
- Can safely use the power wheelchair in your home
Medicare will cover 80 percent of the cost for a scooter or power wheelchair. You will owe 20 percent after you have paid your deductible. Your doctor and supplier must both be enrolled in Medicare. Scooters and power wheelchairs are not covered if you need them only for use outside of your home.
How Much Does Medicare Pay For A Wheelchair
Medicare covers wheelchairs similarly to other durable medical equipment. Medicare Part B will pay 80% of the Medicare-approved cost. Youll pay the remaining 20% after the Part B deductible is met. You may need to either rent or purchase your wheelchair, or Medicare may let you choose between the two options.
If you have Medicare Advantage , you may have different options and costs than Original Medicare members. But because wheelchairs are covered by Original Medicares Part B as durable medical equipment, Part C must provide at least the same level of coverage.
What Is Durable Medical Equipment
Durable medical equipment refers to equipment that you use for medical reasons. This can vary widely, and includes things like canes, blood sugar monitors, oxygen equipment, and hospital beds.
DME is covered by Part B of Medicare when it is medically necessary. This means that you need to use it to treat your health condition. Your doctor will prescribe DME for you and will be able to tell you which equipment you specifically need. DME is subject to the usual Medicare costs, so you will pay a co-insurance in addition to reaching your deductible.
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Eligibility Criteria For Wheelchairs
A decision memorandum by the CMS concludes that the evidence is adequate to determine that wheelchairs in the decision memorandum) are reasonable and necessary for individuals who have a personal mobility deficit sufficient to impair their performance of mobility-related activities of daily living such as toileting, feeding, dressing, grooming, and bathing. The decision memorancum provides the following criteria to be used to assess the presence of a mobility deficit to qualify an individual for a wheelchair:
Assessment Of Your Medical Needs
You must address specific questions in your face-to-face interview with a healthcare provider. Specifically, you or your caregiver must answer:
- What is your mobility challenge and how does it interfere with your daily activities?
- Why cant a cane or walker handle your mobility needs?
- Why cant a manual wheelchair be used to meet your mobility needs?
- Are you capable of transferring to and from the PMD and operating it safely within your home?
- Do you have the physical and mental capacity to operate the PMD by yourself?
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Qualifying & Medicare Criteria For Mobility Scooter Or Electric Wheelchair Coverage :
Now there are much stricter guidelines for doctors and providers who evaluate the patient for a POV. The evaluation is even more lengthy and detailed.
As of January 1, 2011, Medicare beneficiaries can only rent the equipment over a 13-month period. When the 13-month rental period has expired, the supplier will transfer ownership to the beneficiary.
If your doctor submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home, Medicare will help cover any of the types listed below. Generally, Medicare will pay 80% of the Medicare-approved amount, after you have met the Part B deductible. You pay 20% of the Medicare approved amount. Wheelchairs and scooters are also known as mobility assistive equipment.
The patient is unable to operate a manual wheelchair.
The patient is not be able to move around in their home using a wheelchair.
The patient is able to safely operate the controls for the POV.
The patient is able safely transfer into and out of the POV.
The patient has adequate trunk stability in order to be safely drive the POV.
A physician who orders the scooter is one of the following specialties: Orthopedic Surgery, Physical Medicine, Rheumatology or Neurology.
Medicare will not re-reimburse for a POV if its not a medical necessity.
Medicare will not re-reimburse for a POV if it is only used outside the home.
How Do You Get A Scooter From Medicare
First, apply for Medicare Part A and B. Next, there’s a rigorous process, one that starts with a physical examination from your doctor followed by a written prescription.
Your doctor submits the written prescription to Medicare to show your eligibility. Then, you can find a Medicare-approved supplier whether you’d like to rent or buy one.
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Medicare Advantage Coverage For Mobility Scooters
Medicare Advantage, or Part C, is a way for you to get Medicare coverage through private health insurance companies. Although it involves some qualities that are not part of Original Medicare such as provider networks, Part C plans are required to cover the same things that Original Medicare covers.
This means that if an electric scooter is covered by Original Medicare, it will also be covered if you have Medicare Advantage. Medicare Advantage plans will also cover more than Medicare in some cases, such as prescription drugs.
One difference to be aware of is that the cost-sharing under Medicare Advantage may be different from Original Medicare. You may have a different deductible, co-insurance, or co-pay if you have Medicare Advantage medical insurance.
Will Medicare Cover Your Handicapped Scooter
Medicare is a federally funded health insurance program for people over age 65 and those with certain disabilities or medical conditions. While the Social Security Administration enrolls people in Medicare, the Center for Medicare and Medicaid Services runs the program. The Medicare program has several parts and Medicare Part B is dedicated to durable medical equipment such as handicap scooters.
You must meet certain conditions under Medicare Part B for the program to consider fulfilling handicap scooters Medicare reimbursement. For example, you must have a necessary and reasonable need for a mobility device such as a handicapped scooter. Additionally, you must intend to use the mobility scooter primarily in your home and receive an in-person examination from your doctor. Medicare requires your doctor to give you a written prescription for a mobility device such as a scooter before you can receive one. Your doctor must also first consider the use of a cane, walker or manual wheelchair before considering a scooter. The medical need for the scooter must also be documented in your medical records. So, take that first step towards getting coverage for Medicare handicap scooters and schedule a face-to-face appointment with your regular physician.
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Criteria You Must Meet
It should say that a scooter is medically necessary for use in your home, because you have limited mobility and meet all of the following criteria:
- you have a health condition that makes it extremely hard for you to get around within your own home
- you cant do daily living activities, such as using the bathroom, bathing, and dressing, even with a walker, cane, or crutches
- you can safely operate a mobilized 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
You must go to a DME supplier who accepts Medicare. The approved seven-element order must be sent to your supplier within 45 days of your face-to-face doctors visit.
Who Is Eligible For Medicare Scooters
According to their website, Medicare helps cover the costs of mobility scooters for all people who meet the criteria with Medicare Part B. This means that if you are 65 years or older, a citizen of the United States, or at least a resident of the country for five consecutive years, you are qualified to get Medicare Part B.
This medical insurance plan covers a lot of medical services. It also provides coverage for supplies necessary to treat your medical condition. And yes, this includes durable medical equipment such as scooters and wheelchairs.
However, this coverage is only applicable if your doctor submits a written order stating that you have a medical need for a mobility scooter. It is only applicable for those who have limited mobility or if you meet all of these conditions listed below:
- You are not physically able to do activities for daily living using a cane, a walker or a crutch.
- You are suffering from a health condition that makes it difficult for you to move around
- You or your caretaker is able to safely operate the mobility scooter
- Your doctor who is treating you for the condition that requires a wheelchair or scooter and your supplier are both enrolled in Medicare.
If you qualify, please note that you will still pay for 20% of the Medicare-approved amount after you pay your Part B deductible for the year. This means that Medicare will only pay the other 80%. These terms and conditions listed above are only for those who are covered by Medicare Part B.
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How To Get A Medicare
In order to get a prescription for a mobility scooter, you must first have a face-to-face visit with your doctor. Your doctor must document your condition and ability to move around your home. Your documentation needs to say that you cant use other mobility aids, and a scooter is your only option.
The mobility device supplier must receive the order within 45 days of your in-person evaluation.
Does Medicare Advantage Cover Wheelchairs Or Scooters
Medicare Advantage plans are required to offer you, at minimum, the same benefits Original Medicare does, except hospice care. This means that Medicare Advantage plans must offer you the same 80% coverage on a wheelchair that traditional Medicare does. However, theyre provided by private insurance companies, and the copayments and deductibles can vary.
In the event that your Advantage plan denies your request for a DME item or service you believe you need, you can appeal the decision and receive an independent review. If you enroll in a new Medicare Advantage plan while receiving home care or prescribed medical equipment, contact your new primary care provider to ensure that youre covered.
If your Medicare Advantage plan is discontinued while youre using medical equipment, reach out to your plan to learn how to get DME coverage through Original Medicare or another Advantage policy.
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Requirements For Mobility Scooter Coverage
Its helpful to look at Medicares mobility options as a set of stairs. If the mobility aids on one step arent sufficient, you move to the next. The first step is manual mobility aids like walkers and hand-operated wheelchairs. The baseline requirements include:
- The patient is unable to complete daily tasks such as using the bathroom and moving around the kitchen.
- The mobility limitation is not resolved with use of a walker or cane.
- The patient doesnt have the requisite arm and hand strength to operate a manual wheelchair.
If a person is unable to thrive with manual aids, they could be eligible to move to the next step of using a mobility scooter. To be considered for coverage of a mobility scooter, you need to meet the following requirements.
- The patient can safely transfer to and from the scooter.
- The user can operate the tiller steering system.
- The patient can stay safely seated while operating the scooter at home.
- They have the mental and physical ability to operate the device.
- Their home has adequate space to use the mobility scooter.
- Using a scooter will significantly improve the patients ability to complete everyday tasks.
- The patient is willing to use the mobility scooter at home.
If a mobility scooter is not the right option, then the top step is a power wheelchair.
What Will My Out
Also, depending on where you live, your equipment may be subject to Medicares competitive bidding program. If you live in an area where this applies, you must get your scooter from a vendor contracted with Medicare under the competitive bidding program. This can help lower the costs.
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Before picking a supplier, make sure that the supplier, as well as your doctor, are both currently participating in Medicare. Then discuss your payment options and whether you should purchase or rent the wheelchair from the supplier.
Make your decision based on the length of time you will need the device. Part B only pays for a portion of the total cost on your device. Meaning there will be 20% of that cost left for you to pay, out of pocket.
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What Parts Of Medicare Cover Mobility Scooters
Medicare is made up of parts A, B, C, D, and Medigap.
- Medicare Part A is part of original Medicare. It covers inpatient hospital services, hospice care, nursing facility care, and home health care services.
- Medicare Part B is also part of original Medicare. It covers medically necessary services and supplies. It also covers preventive care.
- Medicare Part C is also called Medicare Advantage. Part C is purchased from private insurers. It covers everything parts A and B do, but typically includes additional coverage for prescription drugs, dental, hearing, and vision. Part C plans vary in terms of what they cover and cost.
- Medicare Part D is prescription drug coverage. There are multiple plans available from private insurance companies. Plans provide a list of covered medications and how much they cost, known as a formulary.
- Medigap is supplemental insurance sold by private insurers. Medigap helps pay for some of the out-of-pocket costs from parts A and B, such as deductibles, copays, and coinsurance.
Choosing An Electric Scooter
If your evaluation has established that an electric scooter is the mobility product that best fits your requirements, you can begin to decide what type of scooter you need. There are many styles of scooters with a wide variety of options and accessories. All models of scooters have the same basic features. They have a seat on top of a wheeled platform and a column at the front with controls or hand-rests. The column is called the tiller. The base unit will offer support for your feet and contains the drive system and battery. Your doctor or therapist will have specific results that will help determine your choice. For instance, if you have less hand strength, that will mean that you would have difficulty using hand controls. Other types of controls are available.
The following are other factors to consider:
- Where will you use your scooter? Electric scooters are available in three- or four-wheeled models. If you will be using your scooter primarily outdoors, the four-wheeled model will offer more stability and is easier on rough terrain. The three-wheeled model works well inside since it is easier to maneuver in smaller spaces.
- Will you be taking your scooter with you in your vehicle? There are full-size electric scooters and portable scooters. The portable scooter can be folded and placed in a vehicle. This is good if you are still driving and dont want to purchase an additional scooter lift that is necessary for a full-size scooter.
Changes to Medicare Coverage for 2011
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Will Medicare And My Insurance Company Pay For 100% Of My Hoveround Power Chair
The cost of a motorized chair may vary based on your insurance coverage. However, 9 out of 10 customers receive their Hoveround for little or no cost.1 If you meet their criteria, Medicare will pay 80% of the cost of your Hoveround, and if you have met your deductibles, your supplemental insurance may cover the remaining 20% of the cost.
Please note that the Medicare benefit has been changed to a 13-month rental, with ownership transferred to the beneficiary once full payment has beenmade through Medicare, along with any beneficiary co-pays or deductibles.
1Insurance coverage depends on medical necessity which is determined by your insurer. A valid doctor’s prescription is required.