What are the Medicare requirements for electric scooter coverage?
To qualify for Medicare coverage of an electric scooter, you must meet several strict requirements. The Centers for Medicare & Medicaid Services (CMS) classifies electric scooters as Power Operated Vehicles (POVs) under the Durable Medical Equipment (DME) benefit of Medicare Part B. The primary requirement is that the scooter must be medically necessary for in-home use.
To be eligible for coverage, you must have:
- A qualifying health condition: A diagnosis that causes significant difficulty moving around within your home, even with the use of a simpler mobility aid like a cane, crutch, or walker.
- A face-to-face examination: A physical evaluation by a Medicare-enrolled doctor or other treating provider, who will confirm your medical necessity and ability to safely operate the device.
- A written order: A prescription from your doctor submitted to Medicare stating the medical need for the scooter. This order must be written within 45 days of your face-to-face exam.
- An in-home assessment: Your doctor or the DME supplier must verify that your home layout (including doorways, rooms, and hallways) can accommodate the safe and effective use of the scooter.
- An approved supplier: The scooter must be purchased from a Medicare-enrolled DME supplier who accepts assignment, meaning they agree to accept the Medicare-approved amount as full payment.
Original Medicare vs. Medicare Advantage coverage
Understanding the difference between Original Medicare and a Medicare Advantage Plan is crucial, as coverage rules can vary.
| Feature | Original Medicare (Part B) | Medicare Advantage (Part C) |
|---|---|---|
| Coverage | Covers medically necessary electric scooters as DME. | Must cover at least the same benefits as Original Medicare, and often includes more flexible or additional benefits. |
| Cost | You pay 20% coinsurance of the Medicare-approved amount after meeting the Part B deductible. | Your out-of-pocket costs, such as copayments and deductibles, are determined by your specific plan. |
| Network | You can use any Medicare-enrolled DME supplier that accepts assignment. | You typically must use a DME supplier within your plan's network to ensure full coverage. |
| Prior Authorization | May be required for certain models, especially heavier-duty scooters. | May have specific prior authorization requirements or different rules depending on the plan. |
| Supplemental Coverage | A Medigap policy may cover the 20% coinsurance for the scooter. | Medigap policies generally do not apply to Medicare Advantage plans. |
The process for getting a Medicare-covered electric scooter
Securing a scooter through Medicare involves several steps to ensure all documentation and medical necessity requirements are met. Following this process carefully helps avoid potential delays or claim denials.
- Meet with your doctor: Schedule a face-to-face appointment with your primary care provider (PCP) or another treating physician who is enrolled in Medicare. Discuss your mobility issues and how they impact your ability to perform daily activities inside your home.
- Conduct a home assessment: Your doctor or the DME supplier will need to verify that your living space is suitable for scooter use. They will consider factors like doorway width, hallway clearance, and floor surfaces.
- Obtain a prescription: If the doctor determines a scooter is medically necessary and suitable for your home, they will write a detailed prescription. This is also called a seven-element order, and it must justify the medical need and specify the type of equipment.
- Choose a Medicare-approved supplier: Use the supplier directory on Medicare.gov or get a referral from your doctor to find a DME supplier that is enrolled in Medicare and accepts assignment.
- Seek prior authorization: For certain models, especially more expensive or heavy-duty scooters, your supplier may need to submit a prior authorization request to Medicare before providing the equipment. As of 2025, Medicare has specific timelines for approving these requests.
- Receive your equipment: Once approved, the supplier will arrange for you to receive the scooter. For many standard models, Medicare initially covers the equipment on a rental basis for 13 months, after which you own the device outright.
What happens if your claim is denied?
If Medicare denies your request for an electric scooter, you have the right to appeal the decision. A denial could happen for several reasons, such as insufficient medical documentation or if Medicare believes a simpler device would suffice. The appeals process can be lengthy, but with the right documentation, many denials can be overturned. A strong appeal will often include additional information from your doctor that uses the specific wording Medicare requires to justify medical necessity. It's important to keep track of deadlines and follow all instructions provided in the denial notice.
In some cases, if you have a Medicare Advantage plan, the appeals process may differ, so it's best to contact your specific plan for guidance. Organizations like the Center for Medicare Advocacy can also provide assistance with the appeals process.
Conclusion
Securing an electric scooter through Medicare is a detailed process that involves meeting specific medical necessity and documentation requirements. The key is to work closely with a Medicare-enrolled doctor to obtain a detailed prescription and use a Medicare-approved Durable Medical Equipment supplier. While Medicare Part B covers 80% of the cost after your deductible, patients are responsible for the remaining 20% unless they have supplemental coverage. By understanding these steps and criteria, seniors with qualifying conditions can successfully navigate the process and receive the mobility assistance they need for their independence at home.
