Does Medicare Pay for Motorized Scooters?
Navigate Medicare coverage for motorized scooters, understanding the criteria, necessary steps, and how to obtain vital mobility support.
Medicare Part B may cover motorized scooters, also known as power-operated vehicles (POVs), as durable medical equipment (DME) when specific conditions are met. These devices are designed to enhance mobility for individuals with medical limitations within their home. Understanding the coverage requirements is important.
Medicare Coverage Requirements
Medicare coverage for a motorized scooter hinges on establishing its medical necessity. The individual must have a health condition that significantly impairs their ability to move around within their home. This impairment typically means experiencing severe difficulty performing daily activities such as bathing, dressing, or using the bathroom, even with the aid of a cane, crutch, or walker.
The individual must also be unable to operate a manual wheelchair or use other less sophisticated mobility aids effectively and safely. It is also required that the person can safely operate the motorized scooter themselves, or have a caregiver consistently available to assist with its safe operation. The home environment must also be suitable for the scooter’s use, meaning there is sufficient space for maneuvering.
The scooter’s primary use must be within the home. Medicare does not typically cover devices primarily for outdoor use or for convenience.
Necessary Medical Documentation
Obtaining a motorized scooter through Medicare requires detailed medical documentation. The process begins with a face-to-face examination by a treating physician (MD or DO). This examination must address the individual’s mobility needs and limitations.
During this encounter, the physician documents findings, including the medical necessity for the scooter based on the individual’s health condition and functional impairments. This documentation should provide a clear picture of the patient’s mobility deficits in performing daily activities within their home.
Following the examination, the physician must provide a detailed written order (DWO) for the scooter. This order must include:
The beneficiary’s name
A description of the item
The date of the face-to-face examination
Relevant diagnoses or conditions
The length of need
The physician’s signature and date
The equipment supplier is responsible for obtaining this DWO from the physician before delivery.
Getting Your Scooter
Once medical necessity and documentation requirements are met, obtain the motorized scooter from a Medicare-approved supplier. Choose a supplier enrolled in Medicare that agrees to accept assignment, meaning they accept the Medicare-approved amount as full payment.
Medicare Part B generally covers 80% of the Medicare-approved amount for durable medical equipment, including motorized scooters, after the Part B deductible is met. The individual is responsible for the remaining 20% coinsurance. Medicare typically covers the equipment as a rental for 13 months.
After this 13-month rental period, the individual typically gains ownership. Suppliers coordinate delivery and provide necessary setup or instructions. Medicare may also cover necessary repairs and maintenance if medically necessary.
What to Do If Your Claim is Denied
If a Medicare claim for a motorized scooter is denied, understanding the denial letter is the first step. This letter will provide the specific reason for the denial and outline the individual’s appeal rights. Pay attention to the deadlines for filing an appeal.
The Medicare appeal process involves several levels. The first level is a “redetermination” by the Medicare Administrative Contractor (MAC) that processed the original claim. If the redetermination is unfavorable, the next step is a “reconsideration” by a Qualified Independent Contractor (QIC).
Further levels of appeal include a hearing by an Administrative Law Judge (ALJ) and review by the Medicare Appeals Council. Seeking assistance from resources like State Health Insurance Assistance Programs (SHIPs) can be beneficial. These programs offer free counseling and can help individuals navigate the complexities of the appeal system.