QUESTION: I have arthritis in my hips and knees and have a difficult time getting around anymore. What do I need to do to get a Medicare-covered electric-powered scooter or wheelchair?
ANSWER: If you’re enrolled in original Medicare, getting an electric-powered mobility scooter or wheelchair that’s covered by Medicare starts with a visit to your doctor’s office.
If you’re eligible, Medicare will pay 80% of the cost, after you’ve met your Part B deductible ($203 in 2021). You will be responsible for the remaining 20% unless you have supplemental insurance. Here’s a breakdown of how it works.
Schedule an appointment
Your first step is to call your doctor or primary care provider and schedule a Medicare required, face-to-face mobility evaluation to determine your need for a power scooter or wheelchair. For you to be eligible, you’ll need to meet all of the following conditions:
- Your health condition makes moving around your home very difficult, even with the help of a cane, crutch, walker or manual wheelchair.
- You have significant problems performing activities of daily living, such as bathing, dressing, getting in or out of a bed or chair, or using the bathroom.
- You are able to safely operate, and get on and off the scooter or wheelchair, or have someone with you who is always available to help you safely use the device.
If you’re eligible, your doctor will determine what kind of mobility equipment you’ll need based on your condition, usability in your home and ability to operate it.
It’s also important to know that Medicare coverage is dependent on your needing a scooter or wheelchair in your home. If your claim is based on needing it outside your home, it will be denied as not medically necessary, because the wheelchair or scooter will be considered a leisure item.
Where to buy
If your doctor determines you need a power scooter or wheelchair, he or she will fill out a written order or prescription. Once you receive it, you’ll need to take it to a Medicare-approved supplier within 45 days. To find Medicare-approved suppliers in your area, visit Medicare.gov/medical-equipment-suppliers or call (800) 633-4227.
There are, however, circumstances where you may need “prior authorization” for certain types of power wheelchairs. In this case, you’ll need permission from Medicare before you can get one.
If you have a Medicare supplemental (Medigap) policy, it may pick up some, or all of the 20% cost of the scooter or wheelchair that’s not covered by Medicare. If, however, you don’t have supplemental insurance, and can’t afford the 20%, you may be able to get help through Medicare Savings Programs. Call your local Medicaid office for eligibility information.
Or, if you find that you’re not eligible for a Medicare-covered scooter or wheelchair, and you can’t afford to purchase one, renting can be a much cheaper short-term solution. Talk to a supplier about this option.
For more information about power mobility devices, call Medicare at (800) 633-4227 or visit Medicare.gov/coverage/wheelchairs-scooters.
If you happen to have a Medicare Advantage plan (like an HMO or PPO), you’ll need to call your plan to find out the specific steps you need to take to get a power wheelchair or scooter. Many Advantage plans have specific suppliers within the plan’s network they’ll require you to use.
Jim Miller is editor of the Savvy Senior. Send your senior questions to Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior.org.