Dear wise elder,
I have arthritis in my hips and knees and have difficulty moving around. How do I get a scooter or electric wheelchair covered by Medicare?
Need a ride
If you are registered with the original Medicare, obtaining a scooter or electric wheelchair covered by Medicare begins with a visit to your doctor’s office.
If you are eligible, Medicare will pay 80 percent of the cost once you reach your Part B deductible ($ 203 in 2021). You will be responsible for the remaining 20 percent, unless you have additional insurance. Here’s a breakdown of how it works.
Schedule a meeting
Your first step is to call your doctor or primary care provider and schedule a Medicare-required face-to-face mobility assessment to determine your need for an electric scooter or wheelchair. To be eligible, you must meet all of the following conditions:
- Your medical condition makes it very difficult to move around your home, even with the help of a cane, crutch, walker or manual wheelchair.
- You have significant problems with activities of daily living such as bathing, dressing, getting in or out of a bed or chair, or using the bathroom.
- You can drive safely, get on and off the scooter or wheelchair, or have someone with you who is always available to help you use the device safely.
If you are eligible, your doctor will determine the type of mobility equipment you will need based on your medical condition, its ease of use in your home, and your ability to use it.
It’s also important to know that Medicare coverage depends on your need for a scooter or a wheelchair in your home. If your request is based on needing it outside of your home, it will be refused as not medically necessary as the wheelchair or scooter will be considered a leisure item.
If your doctor determines that you need an electric scooter or wheelchair, they will fill out a prescription or written prescription. Once you receive it, you will need to take it to a Medicare-approved provider within 45 days. To find Medicare approved providers in your area, visit Medicare.gov/medical-equipment-suppliers or call (800) 633-4227.
There are, however, circumstances in which you may need “prior authorization” for certain types of power wheelchairs. In this case, you will need Medicare clearance before you can get one.
If you have a Medicare Supplemental Policy (Medigap), it may cover some or all of the 20% of the cost of the scooter or wheelchair that is not covered by Medicare. If, however, you don’t have supplemental insurance and can’t afford the 20 percent, you may be able to get help through Medicare savings programs. Call your local Medicaid office for information on eligibility.
Or, if you find that you aren’t eligible for a Medicare-covered scooter or wheelchair and can’t afford to buy one, renting may be a much cheaper short-term solution. Talk to a provider about this option.
For more information on electric mobility devices, call Medicare at (800) 633-4227 or visit Medicare.gov/coverage/wheelchairs-scooters.
Advantage of Medicare
If you have a Medicare Advantage plan (such as an HMO or PPO), you will need to call your plan to find out the specific steps for getting a power wheelchair or scooter. Many Advantage plans have specific providers within the plan’s network that they will require you to use.
Send your senior questions to: Savvy Senior, PO Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is an NBC contributor Today show and author of “The wise elder” delivered.