YES! It is possible to have Medicare cover the cost of an electric scooter.
(Consider this post your one-stop Scooter Resource!)
Dear Maria: My mother was diagnosed with MS several years ago and is unable to get around on her own. Does Medicare cover the cost of an electric scooter? What happens if it breaks? Is there an electric scooter parts store or a place where I could buy extra electric scooter batteries to extend the life of it? Thanks for your help. Jessica, Philadelphia, PA
Dear Jessica: It is possible that Medicare will cover the cost of an electric scooter for your mom. However, there are a few critical steps to making sure that the process is smooth.
1. Make sure your aging parent has Part B Medicare
If she has only Part A which covers hospitalizations, she will have to pay for the electric scooter herself unless she has Medicaid or another supplemental insurance plan that might partially cover the cost. If this is the case it’s best to speak directly with her individual plan to find out what may be covered before proceeding. Tip: The easiest way to tell if your mother has Medicare Part B is to look at her Medicare card – if there is a “B” after her i.d. number, this would indicate the Part B coverage.
2. Speak with the doctor
Your mother’s diagnosis of MS must be clearly documented in her medical record and her doctor must be willing to write a prescription for the electric scooter. In addition, the physician must describe your mother’s day-to-day functioning in her medical record so that it’s clear that not having an electric scooter severely limits her independence. It’s important that he or she is very specific on this point.
Why is documentation so critical?
Medicare will want to be sure that your mother’s upper body strength is such that she cannot use a traditional wheelchair for mobility and that without the electric scooter, she would essentially be confined to a chair or bed. At the same time however, it must be noted that your mother could safely transfer on and off the electric scooter and operate the manual controls. Assuming that your mother’s daily functioning is significantly impacted by her illness to the point I’ve just described, the physician should be willing to make the appropriate notations in the chart (if they’re not there already) and write the necessary prescription.
3. Be prepared for the co-pay
As with other equipment covered by Medicare, the recipient of the electric scooter will be responsible for 20% of the cost. If you mother has Medicaid or another supplemental policy, it’s possible that one of these plans will pick up the co-pay amount so it would be important to check before proceeding.
4. Choose a vendor
Choosing a vendor to work with in ordering the electric scooter is an important step in the process. While you can purchase an electric scooter from any store that sells them, Medicare will only pay for electric scooters purchased through a Medicare approved provider. Each approved provider will have an official Medicare supplier number. Once you’ve found a Medicare approved provider, that provider can still fall into one of two categories with important distinctions between them.
The two types of vendors and why this matters
The first category of electric scooter vendors is what is known as “participating suppliers” or those who “accept assignment”. A vendor in this category has agreed that they will be paid my Medicare and will only charge you (or the supplemental insurance plan you may have) the 20% co-pay.
The second category is comprised of those vendors who don’t participate or don’t accept assignment. This group of providers is able to charge up to 15% more than the Medicare rate. This category of providers may also want you to pay for the scooter in full and then wait for the Medicare reimbursement.
If you go with a vendor in category 2, keep in mind that it can take three to six months to receive the reimbursement from Medicare, maybe longer.
What if my aging parent participates in a managed Medicare (also known as a Medicare Advantage) plan?
Great question! In this case there may be a list of pre-approved vendors that she must purchase from or risk not having the electric scooter covered at all. My best advice here is to call the individual plan to inquire about a pre-approved vendor list before doing anything else.
Who covers the maintenance of an electric scooter?
Regardless of whether your mother ultimately chooses to rent or own her electric scooter (she’ll be given the option in writing after nine months), she will be responsible for 20% of the cost of the scooter’s maintenance unless she has Medicaid or a supplemental insurance plan that may pay this 20% – another important thing to check. Since maintenance is a routine part of the package so-to-speak, under Medicare’s guidelines, I would not be concerned with finding extra electric scooter parts or electric scooter batteries. Leave that task to the vendor who will perform the maintenance.
5. Just like dress shopping, make sure it fits before you buy!
Before an electric scooter is selected, it’s a good idea to measure the door frames in your mother’s home so you can be sure which models will fit. Also, your mother should be part of selecting the scooter if at all feasible. She will spend significant time in this piece of equipment so it’s important to be sure it is both comfortable and easy to use.