If you have trouble getting around your home and think you may need the assistance of an electric scooter, Medicare may cover it.
Qualifying for an electric scooter
You may qualify for electric scooter coverage if the following applies to you:
- Your doctor finds it medically necessary.
- You obtain a prescription, certificate, or order at least 45 days before receiving the equipment.
- Your order states the following information:
- Your health makes it hard to safely navigate your home.
- You have problems performing daily tasks in your home.
- You are unable to use a manual wheelchair.
- You have received this order at least 45 days before obtaining the equipment.
Original Medicare coverage
Medicare Part B covers electric scooters, power wheelchairs, walkers, and manual wheelchairs as durable medical equipment (DME). If you are approved for one of these items, you will need to pay the Part B deductible and 20 percent of the cost of equipment and services. Medicare will pay the remaining 80 percent.
You may be limited to which DME supplier you can use depending on where you live. In some areas, you can use any supplier, while other areas limit your options. Talk to your doctor about which DME suppliers will be covered by Original Medicare.
Depending on the type of equipment Medicare covers in your area, you may be able to rent or buy your equipment, or choose between renting and purchasing.
Medicare Advantage coverage
Coverage of an electric scooter may vary based on which Medicare Advantage plan you have. Call your plan directly to find out if you have coverage.
You may also have to follow your plan’s rules to obtain an electric scooter. For example, you may have to:
- Get your plan’s approval before you receive the DME,
- Choose an in-network supplier, and
- Select a preferred brand of electric scooter to find the best price.
Prior authorization for power wheelchairs
If you need a power wheelchair, a new Medicare rule (September 1, 2018) states that you have to receive prior authorization for these 33 types of power wheelchairs before Medicare will cover them. Your DME supplier will need to file this prior authorization request for you by sending the necessary documents directly to Medicare.
Medicare may deny your prior authorization request if:
- Medicare does not think your need for a power wheelchair is medically necessary.
- Medicare receives insufficient documentation.
If denied, your DME supplier may resubmit your request for prior authorization.
Competitive Bidding Program
If you live in certain areas, you may be affected by Medicare’s Competitive Bidding Program. In most cases, Medicare will only help pay for equipment and supplies if they’re provided by contract suppliers.
Contract suppliers can’t charge you more than 20 percent coinsurance and any yearly deductible for equipment or supplies included in the Competitive Bidding Program. Under Medicare rules, you own these types of equipment after renting them for 13 months.
Once you own the equipment, you must get replacement supplies and accessories from a contract supplier in order for Medicare to help you pay for them. You’ll need to request repairs for the equipment directly from your Medicare-approved supplier, including replacement parts needed for the repair.
To find out more about Medicare coverage, visit medicare.gov or call Medicare directly at 1-800-MEDICARE.