Does Medicare Cover a Knee Scooter?

Navigating healthcare coverage can be complex, especially when seeking support for mobility challenges. Individuals recovering from injuries or surgery, particularly those involving the lower leg, ankle, or foot, often find that a knee scooter can significantly aid mobility and comfort. Understanding how Medicare addresses coverage for such equipment is a common concern for many beneficiaries. This article explores Medicare’s approach to knee scooter coverage, outlining the distinctions between Original Medicare and Medicare Advantage plans, along with the associated requirements and financial considerations.

Medicare Coverage of Knee Scooters

Knee scooters, also known as knee walkers, are classified as Durable Medical Equipment (DME). Original Medicare, specifically Part B (Medical Insurance), generally does not cover knee scooters. This is often because crutches are considered a less expensive alternative that serves a similar function.

Medicare Advantage (Part C) plans may offer different coverage options. These private insurance plans contract with Medicare to provide Part A and Part B benefits, and are required to cover at least the same medically necessary services as Original Medicare. However, Medicare Advantage plans can offer additional benefits or have different rules and networks for DME, which might include coverage for knee scooters. Beneficiaries enrolled in a Medicare Advantage plan should directly contact their plan provider to understand specific coverage details and any associated requirements.

Meeting Coverage Requirements

For a knee scooter to be covered by a Medicare Advantage plan, it must meet several Durable Medical Equipment (DME) criteria. A valid prescription from a doctor or other healthcare provider, such as a nurse practitioner or physician assistant, is required. This prescription certifies the knee scooter is medically necessary for home use. Medical necessity documentation should explain why the scooter is needed, such as preventing weight-bearing on an injured limb, addressing an inability to use crutches, or facilitating safe mobility during recovery.

Beyond the prescription and medical necessity, the knee scooter must be obtained from a Medicare-enrolled supplier. This ensures the supplier adheres to Medicare’s standards for claims submission. Some situations, particularly with certain DME items or specific Medicare Advantage plans, may necessitate prior authorization. This involves the plan reviewing medical necessity before approving coverage, helping to avoid unexpected costs.

Getting Your Knee Scooter

Once all requirements are met, including obtaining a prescription and understanding potential Medicare Advantage plan coverage, the next step is acquiring the knee scooter. Locating a Medicare-approved supplier is key. Beneficiaries can find these suppliers through the Medicare.gov website’s directory or by contacting 1-800-MEDICARE. Confirm the chosen supplier accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment.

The supplier will work with the beneficiary to submit a claim with the necessary documentation, including the physician’s prescription and medical records. Depending on the specific DME item and the plan’s policies, the knee scooter might be covered through rental or purchase. Many DME items are initially rented, with payments potentially contributing towards a purchase after about 13 months. After the claim is submitted, the beneficiary will receive an Explanation of Benefits (EOB) from their Medicare Advantage plan, detailing the approved amount and plan payment.

Your Financial Responsibility

Even with Medicare Advantage coverage, beneficiaries typically have financial responsibilities. If the plan mirrors Original Medicare’s cost-sharing for DME, beneficiaries must first meet their annual Medicare Part B deductible. For 2025, this deductible is $257. After meeting the deductible, Medicare generally pays 80% of the approved amount for covered DME, leaving the beneficiary responsible for 20% coinsurance.

If the supplier or Medicare Advantage plan believes Medicare might not cover an item, an Advance Beneficiary Notice of Noncoverage (ABN) may be issued. Signing an ABN acknowledges potential financial responsibility if Medicare denies coverage, often due to lack of medical necessity or policy exclusions. Medicare Advantage plans have their own cost-sharing structures, including varying deductibles, copayments, and coinsurance amounts. Beneficiaries should always consult their specific plan documents for precise financial obligations.