Medicare covers mobility scooters, but only under specific conditions and through a defined process

Medicare Part B covers a motorized scooter (called a power-operated vehicle or POV in Medicare language) if your doctor prescribes it as medically necessary and you meet Medicare's requirements. The scooter must be for use in your home, and you must have a condition that limits your ability to walk. Medicare does not cover scooters for outdoor use only or for convenience.

The coverage is not automatic. You need a written order from your doctor, a face-to-face evaluation, and approval from Medicare before you purchase or rent the scooter. If you buy one without going through this process, Medicare will not reimburse you. The process typically takes several weeks.

Medicare covers 80 percent of the approved amount after you have met your Part B deductible for the year. You pay the remaining 20 percent, unless you have a Medigap or Medicare Advantage plan that covers this cost-sharing.

Key Takeaways

  • Your doctor must document that you cannot walk more than 150 feet without stopping to rest, or cannot walk at all without information, for Medicare to consider a scooter medically necessary.
  • You must have a face-to-face visit with your doctor within 6 months before the order is written; a telehealth visit does not count for this requirement.
  • You must obtain a written prescription from your doctor and submit it to a Medicare-approved supplier, who then requests Medicare's approval before you take the scooter home.
  • Medicare pays 80 percent of the approved amount; you are responsible for 20 percent plus any difference between the approved amount and what the supplier charges.
  • Renting a scooter from a Medicare-approved supplier costs less upfront than buying, and Medicare covers rental the same way it covers purchase.

What your doctor needs to document

Your doctor must write a detailed order that explains why you need a scooter. Medicare requires the order to state that you have a condition that prevents you from walking more than 150 feet without stopping to rest, or that you cannot walk without the help of another person. Common conditions that meet this standard include severe arthritis, heart disease, lung disease, neurological conditions, and amputation.

The order must also state that you have tried a cane or walker and found it insufficient, or that your condition makes a cane or walker unsafe or impossible to use. Your doctor does not need to perform any special test; the order is based on your medical history and what your doctor observes during your visit.

The order must be dated and signed by your doctor. Physician assistants and nurse practitioners can also write the order if they are working under a doctor's supervision and are authorized by your state to do so.

The face-to-face visit requirement

Medicare requires that your doctor see you in person within 6 months before writing the scooter order. This visit must take place in the doctor's office, clinic, or hospital—not by phone or video. The visit does not have to be specifically about your mobility; it can be a routine checkup or a visit for another condition, as long as your doctor documents your walking ability during that visit.

If you have not seen your doctor in person within the past 6 months, you will need to schedule an appointment before the order can be written. This is one of the most common reasons applications are delayed.

How to request Medicare approval

Once your doctor writes the order, you do not submit it directly to Medicare. Instead, you take the order to a Medicare-approved durable medical equipment (DME) supplier. The supplier is the company that will rent or sell you the scooter. You can find approved suppliers in your area by visiting Medicare.gov and using the supplier search tool, or by calling Medicare at 1-800-MEDICARE.

The supplier will submit the order and your medical information to Medicare for review. This is called a prior authorization request. Medicare typically responds within 10 to 14 business days. If Medicare approves the request, the supplier will contact you to arrange delivery or pickup. If Medicare denies the request, the supplier will tell you why, and you have the right to appeal.

Do not purchase or rent a scooter from a supplier who is not on Medicare's approved list. If you do, Medicare will not cover any of the cost.

Renting versus buying

You can either rent or buy a scooter through a Medicare-approved supplier. Rental is usually the better choice if you are unsure whether you will need the scooter long-term or if you want to try it before committing to a purchase.

Medicare covers rental at 80 percent of the approved amount. After 13 months of continuous rental, you own the scooter. At that point, Medicare stops paying the rental fee, but you keep the scooter. If you buy a scooter outright instead of renting, Medicare covers 80 percent of the purchase price up to the approved amount.

The approved amount varies by region and by the type of scooter. A basic three-wheel scooter typically has a lower approved amount than a four-wheel scooter with more features. Ask the supplier what the approved amount is for the specific model you want before you commit.

What happens if Medicare denies your request

Medicare may deny your request if your doctor's order does not clearly show that you meet the walking limitation standard, if the face-to-face visit was more than 6 months before the order, or if Medicare determines the scooter is not medically necessary for your condition.

If your request is denied, the supplier will send you a notice called a Detailed Explanation of Non-Coverage (DENC). This notice explains why Medicare said no and tells you how to appeal. You have 120 days from the date of the notice to file an appeal.

To appeal, you can ask your doctor to provide additional medical information, or you can ask your doctor to write a new order with more detail about your walking limitations. Some people succeed on appeal after their doctor submits additional documentation. You do not need a lawyer to appeal, though you can hire one if you choose.

Your out-of-pocket costs

After Medicare approves your scooter, you will owe 20 percent of the approved amount. You will also owe your Part B deductible if you have not met it yet this year. The Part B deductible amount changes each year; you can find the current amount on Medicare.gov.

If the supplier charges more than Medicare's approved amount, you are responsible for the difference. This is called excess charges. To avoid surprise bills, ask the supplier in writing what the approved amount is and confirm that they will not charge you more than 20 percent of that amount plus your deductible.

If you have a Medigap plan, it may cover your 20 percent cost-sharing. If you have a Medicare Advantage plan, your out-of-pocket costs depend on your plan's rules. Check your plan documents or call your plan to find out what you will owe.

Frequently Asked Questions

Can I buy a scooter on my own and then ask Medicare to reimburse me?

No. Medicare only covers scooters that are ordered through the prior authorization process before you purchase or rent them. If you buy a scooter without Medicare approval first, Medicare will not pay for any part of it, even if you later meet all the requirements.

What if my doctor says I need a scooter but Medicare says I don't?

You can appeal Medicare's decision. Ask your doctor to submit additional medical records or a detailed letter explaining your walking limitations. Some appeals succeed when doctors provide more specific information about how far you can walk and what happens when you try to walk without a scooter.

Does Medicare cover scooters for outdoor use only?

No. Medicare covers scooters only for use in your home. If you need a scooter primarily for outdoor activities or travel, Medicare will not cover it. Some private insurance plans or state programs may cover outdoor scooters, so ask your doctor or supplier about other options.

How long does the whole process take?

The process typically takes 4 to 6 weeks from the time your doctor writes the order to the time you receive the scooter. This includes time for the supplier to submit the request, Medicare to review it, and the supplier to arrange delivery. If Medicare denies the request, the appeal process can take several additional weeks.

What if I already own a scooter and want Medicare to cover it now?

Medicare cannot reimburse you for a scooter you already own. However, if you need a different model or a replacement, you can start the prior authorization process for a new scooter going forward.