Dear Savvy Senior: What’s the process for getting Medicare to pay for an electric mobility scooter or power wheelchair? My 76-year-old mother has arthritis in her knees and hips, and has a difficult time getting around anymore. — Searching Daughter
Dear Searching: Getting an electric-powered mobility scooter or wheelchair for your mom that’s covered by original Medicare starts with a visit to her doctor’s office. If eligible, Medicare will pay 80 percent of the cost, after she meets her $147 Part B deductible. She’ll be responsible for the remaining 20 percent.
Here’s how it works:
MAKE AN APPOINTMENT
Your first step is to call your mom’s doctor and schedule a Medicare required, face-to-face mobility evaluation, to determine her need for a power wheelchair or scooter. For your mom to be eligible, she’ll need to meet all of the following conditions:
■ Her health condition makes moving around her home very difficult, even with the help of a cane, walker or manual wheelchair.
■ She has significant problems performing daily living activities such as bathing, dressing, getting in or out of a bed or chair, or using the bathroom.
■ She can safely operate, and get on and off the scooter or wheelchair, or have someone with her who is always available to help her safely use the device.
If eligible, your mom’s doctor will determine what kind of mobility equipment she’ll need based on her condition, usability in her home and ability to operate it.
It’s also important to know that Medicare coverage hinges on your mom needing a scooter or wheelchair in her home. If her claim is based on needing it outside her home, it will be denied as not medically necessary, because the wheelchair or scooter will be considered a leisure item.
WHERE TO SHOP
If the doctor determines your mom needs a power scooter or wheelchair, he or she will fill out a written order or certificate of medical necessity form for your mom. Once she gets that, she’ll need to take it to a Medicare approved supplier within 45 days. If your mother happens to live in one of Medicare’s competitive bidding areas, you’ll need to get her device from specific suppliers approved by Medicare. To find approved suppliers and competitive bidding suppliers in your area, visit medicare.gov/supplier or call 800-633-4227.
Once you choose an approved supplier, that supplier will send a representative to assess your mom’s home, measuring her doorways, thresholds and overall space to ensure she gets the appropriate mobility device.
If your mom has a Medicare supplemental policy, it may pick up some or all of the 20 percent cost of the scooter or wheelchair that’s not covered by Medicare. If, however, she doesn’t have supplemental insurance, and can’t afford the 20 percent, she may be able to get help through Medicare Savings Programs. Call your local Medicaid office for eligibility information.
If you find that your mom is ineligible for a Medicare- covered scooter or wheelchair, and she can’t afford to buy one, renting can be a cheaper short-term solution. Talk to a supplier about this option.
For more information, call Medicare at 800-633-4227 and request a copy of publication No. 11046 “Medicare’s Wheelchair and Scooter Benefit,” or you can read it online at medicare.gov/publications/pubs/pdf/11046.pdf.
If your mom happens to have a Medicare Advantage plan (like a health-maintenance organization or preferred provider organization), she’ll need to call her plan to find out what specific steps she needs to take to get a wheelchair or scooter. Many Advantage plans may have specific suppliers within the plan’s network they’ll require her to use.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit savvysenior.org. Jim Miller is a contributor to the NBC’s “Today “and author of “The Savvy Senior” book.