Being unable to move about on your own is not only a limit on your independence; it can affect your health. There are medical problems that can result from a lack of mobility including deep venous thrombosis, osteoporosis, malnutrition, and poor hygiene. Your lack of mobility can prevent you from going out, and can even affect getting around in your own home.
Fortunately, there are options to keep your independence—mobility scooters for seniors. They aren’t just about convenience, a scooter or motorized wheelchair can also improve your health. Mobility scooters (medical scooter, elderly scooter) may be covered by Medicare. Mobility scooter lifts, for stairs or vehicles, are not necessarily covered.
The Center for Medicare and Medicaid Services (CMS) determined that these devices are “reasonable and necessary for beneficiaries who have a personal mobility deficit sufficient to impair their participation in mobility-related activities.” These mobility-related activities include basic daily functions such as washing, bathing, and cooking. Medicare often refers to mobility scooters as “mobility assistive equipment” or MAE. This term refers not only to mobility scooters, but to everything from canes to power wheelchairs and vehicles.
How do I become eligible for a mobility scooter?
- There are a few things. It starts, however, with your health care provider.
Your doctor needs to submit a written order saying you have a medical need for a scooter (or wheelchair) in your home. You must have a personal checkup with your doctor—you cannot request a scooter over the phone. Also, you must primary need the scooter for use in your home—it cannot be mainly for recreational or outdoor use. However, this doesn’t imply that you can never use it outside the home.
Qualifying Conditions
- You must meet each of these qualifying conditions:
- A health condition that makes it hard for you to move in your home.
- Daily activities are impossible even with use of a cane, crutch, or walker. Activities include bathing, dressing, getting in and out of bed (or chairs) or using the restroom.
- You need to be able to operate the scooter or wheelchair, or have a caregiver help you use the scooter/wheelchair safely.
- The equipment must be usable in your home with open pathways.
You qualify for a motorized wheelchair if you are unable to operate a manual chair. But to qualify for a mobility scooter, you must be physically able to sit upright and operate the controls. This sounds easy but some health conditions may make one or the other (or both) impossible. Your physician can help determine if you are capable of using a scooter safely.
Medicare Coverage
If Medicare approves, they will pay 80 percent of the Medicare-approved amount, while you pay 20 percent. You must also meet the Medicare Part B deductible. Anything covered under Medicare must fit into a benefit category and not be excluded by law. In some states, you may need to get your scooter or wheelchair from a specific, approved supplier. If you only need a scooter for a short time, it may be financially feasible to rent one. Be aware that some unscrupulous individuals and companies have taken advantage of Medicare policies regarding mobility scooters.
A couple of things to keep in mind regarding potential fraud include:
- A company that offers you a free wheelchair or scooter. Even if you qualify you will likely have to pay 20 percent.
- A company that offers to waive your copayment.
- If Medicare is billed for equipment you never received.
- If Medicare is billed for equipment after it is returned.
There are also different types of scooters to consider—some have three wheels and others include four. There are scooters that are designed for indoor use and others that are more versatile. Look for a scooter that will fit in
your living space and that you can use easily.
- If you are having difficulty with mobility or feel that you aren’t able to get around safely, there are mobility products available to help you. A mobility aid will allow you to maintain your independence and improve your safety from falls and injuries. These aids range from canes and walkers for people who are fairly mobile, to electric scooters, manual wheelchairs, and power wheelchairs for those with significantly decreased mobility. If you fall into the last category, an evaluation is necessary to determine if a scooter, manual wheelchair, or electric wheelchair is best for your needs.
Get an Evaluation
- The first step in getting a mobility aid is to be evaluated by your doctor. An occupational therapist may conduct your evaluation, but the doctor must first write a prescription if you are using your Medicare coverage. The doctor or therapist uses certain criteria to decide which mobility product is best for you.
The following will be checked during your evaluation:
- Your overall strength: If your upper body and legs are weak, you may not have the strength to use an electric scooter or manual wheelchair. To use a scooter, you have to be able to hold yourself upright without assistance or support.
- Your upper-body strength: Even if you have sufficient body strength, you must have enough strength in your upper body, arms, and hands in order to operate a mobility scooter. Your upper-body strength will also determine if you are able to operate a manual wheelchair or if you need an electric wheelchair.
- Your balance: If your balance is impaired and your posture is poor, you may not be able to remain upright to use a manual wheelchair or stay on a scooter.
Choosing and Electric Scooter
If your evaluation has established that an electric scooter is the mobility product that best fits your requirements, you can begin to decide what type of scooter you need. There are many styles of scooters with a wide variety of options and accessories. All models of scooters have the same basic features. They have a seat on top of a wheeled platform and a column at the front with controls or hand-rests. The column is called the tiller. The base unit will offer support for your feet and contains the drive system and battery. Your doctor or therapist will have specific results that will help determine your choice. For instance, if you have less hand strength, that will mean that you would have difficulty using hand controls. Other types of controls are available.
The following are other factors to consider:
- Where will you use your scooter? Electric scooters are available in three- or four-wheeled models. If you will be using your scooter primarily outdoors, the four-wheeled model will offer more stability and is easier on rough terrain. The three-wheeled model works well inside since it is easier to maneuver in smaller spaces.
- Will you be taking your scooter with you in your vehicle? There are full-size electric scooters and portable scooters. The portable scooter can be folded and placed in a vehicle. This is good if you are still driving and don’t want to purchase an additional scooter lift that is necessary for a full-size scooter.
Medicare Coverage for Electric Mobility Scooters
Medicare Part B will cover most of the cost of electric mobility scooters, but only if your doctor determines that it is medically necessary. The scooter must also be used primarily for moving about your home and not as a “recreational” vehicle. You may have to pay up to 20% of the cost after meeting your Part B deductible.
Other requirements for Medicare coverage include:
- Your evaluation must be with a doctor or other qualified health provider
- The evaluation must be documented and say that you need a mobility aid for a medical condition (called a “Certificate of Medical Necessity)
- You must present the order or prescription to the Medicare-approved electric scooter supplier before Medicare can be billed
- You must be able to safely operate, and get on and get off of the scooter
- You must have good vision
- You must have a health condition that causes difficulty for you to move around in your home
Changes to Medicare Coverage for 2011
There have been changes to Medicare coverage for “Durable Medical Equipment,” which includes things like medical supplies and electric mobility scooters. It’s important that you read and understand these changes. In an effort to cut costs, Medicare began to implement what is called “Competitive Bidding” at the end of 2010. This meant that Medicare-approved providers and suppliers of durable medical equipment were required to submit competitive bids for their products. There is a selection process in which the “winning” bids and those suppliers become Medicare-approved.
Also, there are now much stricter guidelines for doctors and providers who evaluate your need for a mobility aid. These evaluations have always been face-to-face for Medicare to approve a wheelchair or scooter, but now these evaluations are even more lengthy and detailed.
If you have questions about covered suppliers, go to www.medicare.gov/supplier where Medicare-approved suppliers are listed or call 1-800-MEDICARE (1-800-633-4227).
