One of the most challenging aspects of the elderly or those with a disability is mobility. Getting around to do the things when your health does not permit it is a major concern for many. It isn’t just a matter of being able to get to the places you want to go; mobility is directly connected to your personal sense of independence and freedom. When you have limitations that restrict your freedom of movement, you lose a bit of your quality of life in the process.
But getting a mobility scooter is not always easy. Many of them are priced well out of the reach of the average person’s fixed income. While obtaining one may seem like it is out of your hands, there is a way to get a mobility scooter for free through your Medicare coverage. Simply by following a few basic steps, you will have your freedom of movement and be back on track in no time.
You Have to Show a Medical Need
If you feel that you have a medical need for a mobility scooter, you need to first consult with your primary care provider. After an open and frank discussion, if your provider agrees that it is a medical necessity, they will write you a prescription or an order for a scooter. The order will have to include the following information:
- Your health is prohibiting you from getting around without a walker or a cane
- You are having difficulty performing regular routine activities (bathing and dressing) in your home
- You are unable to use a manual wheelchair but are capable of using an electric scooter
- The scooter will help alleviate some of the medical challenges you have at home
- That you have had a face-to-face consultation with your doctor and he/she agrees with this assessment. Please note that the order from the doctor must be written within 45 days of your consultation for it to be valid.
Once you have the order from the doctor in hand, you simply take it to a Medicare approved supplier to get coverage.
Finding a Medicare Supplier
There are many suppliers that can deliver you a quality mobility scooter, but they are not all Medicare approved. If you want your insurance to cover your new scooter, then it is very important that you find the right supplier.
If you have the traditional Medicare plan, the supplier you choose will depend on your location and the type of scooter you need. For example, if you live in a large city where many companies are competitively bidding to provide supplies, Medicare will only cover scooters from those companies that offer a lower DME (durable medical equipment) costs, but also provide improved quality merchandise.
If you do not live in an area where there are a lot of suppliers competitively bidding, you will have to look for a Medicare-approved supplier that will take orders on assignment.
If you have the Medicare Advantage Plan, you will have to follow the rules and guidelines established for acquiring covered DME. Not all of these plans are the same, so your plan may have some of the following requirements:
- Get Medicare’s prior approval before ordering your scooter
- Get the scooter from an approved network of suppliers
- You may only get zero or partial coverage if you choose a supplier outside of the network
- Only use an approved brand of scooter
- You may have to pay if you choose a non-preferred brand
Those who have the Medicare Advantage Plan are not impacted by the competitive bidding clause required with the traditional Medicare coverage, so the process is likely much simpler.
About Competitive Bidding
Medicare’s competitive bidding program was created to aid in lowering the cost of out-of-pocket expenses for the patient but at the same time ensure that they are getting high quality goods. The suppliers under their umbrella are required to:
- Provide the necessary service to any traditional Medicare beneficiary living in their area
- Take assignment and accept Medicare’s approved amount as full payment
- Are the only suppliers in the area that are allowed to bill Medicare for ordered items
Watch Out for Fraud
Because there is such a high demand for mobility scooters, you will find many suppliers who are not Medicare approved. While most can be considered honest, there are some that will try to cheat the system. They may offer you an expensive scooter even though they are not approved or are aware that your plan does not cover the costs. Then, when your claim is denied, will expect you to pay. When talking to suppliers, never accept their word that they have been Medicare approved. Ask to see current documentation and proof before giving them your order.
Getting the mobility you need is not always easy, but getting your Medicare insurance to cover your new mobility scooter is not very difficult either. As long as you are willing to comply with all of the requirements laid out by your plan, and can show that you have a legitimate medical need, you should have no problems getting them to cover the full cost of scooter.