At least once a day I get the question: Does Medicare cover mobility scooters? The short answer is Yes! Medicare does cover mobility scooters. Of course, there are a few caveats to this. And a lot of rules. And a few hoops to jump through too.
Here are my tips for getting Medicare to cover your mobility scooter.
Video Guide to Medicare Scooter Coverage
Questions to Ask Yourself
Before putting yourself through the process of trying to get a scooter through your Medicare plan, ask yourself the following questions:
- Can you walk from the couch to the bathroom or kitchen without needing any assistance?
- Can you walk from the couch to the bathroom or kitchen with a cane, walker, or rolling walker?
- Do you only need assistance outside of the home for longer periods of walking?
If you answered “yes” to any of these questions, you probably do not qualify under current Medicare guidelines. Here’s why.
The Medicare MRADL Guideline
Before Medicare will cover your scooter (or other wheelchairs for that matter), your doctor or another healthcare professional must state and certify that you can not perform your MRADL’s even with a cane, crutch, walker, or a manual chair. MRADL stands for Mobility Related Activities of Daily Living. These are the 5 critical activities that a person needs to be able to do to take care of themselves in their home: bathing, toileting, personal care, feeding, and dressing.
Your medical documents must specifically state this. No if’s, and’s, or but’s. They must say in clear language something like “The patient requires a scooter to be able to get to the bathroom for toileting and the kitchen for feeding or they cannot perform these ADL’s”
Medicare Scooter Coverage Guidelines
To get your scooter covered by Medicare, the submitted documentation must indicate that you have limited mobility and meet the following conditions:
- You have a health condition that causes significant difficulty moving around your home
- You are unable to do the activities of daily living (MRADL’s) that I listed above even with a cane, crutch, or walker. The medical record must also explicitly state WHY you cannot use a cane, crutch, or walker.
- You are unable to do these activities with a manual wheelchair with an explanation why.
- You can safely operate a scooter and can also safely get off and on the scooter
- Your doctor and supplier must be enrolled in Medicare.
- The equipment must be usable and fit in your home to accomplish the MRADL’s
So, if you feel you meet all these conditions, here is what you need to do to get your scooter covered.
How to Document Your Need for a Scooter
You must obtain the proper documentation from your doctor and other health professionals to prove your need for the scooter. The process should always start with your doctor, usually your family doctor.
The Face-to-Face Appointment
The first step is to schedule an in-person appointment with your doctor. When you schedule this appointment, make sure the doctor’s office staff understands this is for a Medicare Face to Face mobility evaluation. Here is what needs to happen at this appointment:
- The primary purpose stated in the record of the appointment must be that you are there for a face to face mobility evaluation. It CANNOT say you are there for a check-up, a sick visit, or lab work or Medicare may not accept the record.
- Your doctor must address each of the guideline conditions above, in writing, in the progress notes from the visit.
- These conditions must be documented with objective measurements like strength measurements and the range of motion in all your joints. Objective means he/she must use numbers like 3-/5, etc.
- Your doctor must describe your ambulation in terms of how far you can walk, what your gait is like, your oxygen levels while walking etc.
As you can see, to satisfy Medicare guidelines, a thorough mobility evaluation is needed. To do a complete evaluation is probably going to take 30 minutes or more. The problem: many doctors aren’t able to spend that amount of time.
So, What’s Next?
After this visit, your doctor will usually send your information to a local durable medical equipment supplier. The DME company will have someone help you complete the rest of the required paperwork. They will also measure your home to make sure a scooter will fit in your home and maneuver properly in it. This is also a Medicare requirement.
Curious if a mobility scooter is right for you? Check out this guide to the advantages and disadvantages of scooters.
Do you have any experience or advice to share about getting a mobility scooter? If so, leave them in the comments below. Also, questions are always welcome too!