Where did all the advertisements for scooters go? New rules have made it harder and harder for Medicare to cover scooters for seniors.
It wasn't so long ago that a prominent “scooter store” got itself in a pickle for pushing doctors to write prescriptions for Medicare furnished scooters (whether necessary or not).
Scrutiny surrounding The Scooter Store case has led to tighter restrictions on Medicare covered scooters, making eligibility for these scooters a complicated issue to wade through.
Here's CBS News discussing The Scooter Store's advertisements which targeted seniors all over the country:
Some members of Congress say the ads lead to hundreds of millions of dollars in unnecessary spending by Medicare, which is only supposed to pay for scooters as a medical necessity when seniors are unable to use a cane, walker or regular wheelchair. According to congressional testimony, Medicare accounted for about 75 percent of The SCOOTER Store's revenue. – CBS News
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The Medicare spending issues surrounding scooters and other durable medical equipment (DME) led to tighter restrictions on where you can purchase scooters for seniors, who is eligible for Medicare reimbursement, and the steps you need to take in order to be in compliance with Medicare Part B (medical insurance) rules. Let's dig into the details…
Who is eligible for a Scooter covered by Medicare?
Medicare.gov says that all people who meet criteria with Medicare Part B are covered for scooters (which they define as “manual wheelchairs & power mobility devices”).
What steps do I need to take?
Keep these facts in mind as you consider the steps you need to take when considering a scooter for mobility;
- Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home.
- You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair.
- Power wheelchairs are covered only when they're medically necessary.
Where can I purchase a scooter?
You can purchase a scooter anywhere you wish if you're paying out of pocket. You can find them online (new and used) or you can visit your local DME supplier in town.
If you're planning on some help from Medicare however, you need to visit an enrolled DME supplier that accepts the assignment cost from the federal government. Here's more:
Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.
It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you. – Medicare.gov
How much will it cost me?
If your DME provider accepts the Medicare assignment costs, you'll be paying 20% of the Medicare-approved amount, and then the Part B deductible applies. Medicare.gov says, “depending on the type of equipment, you may need to rent the equipment, you may need to buy the equipment, or you may be able to choose whether to rent or buy the equipment.”
After you've visited your (Medicare enrolled) doctor, and he/she has written you a prescription for a scooter, you can obtain details from a (Medicare enrolled) DME provider, and they can share options with you. General prices for a decent (new) scooter will range from $750-$2,000.
Scooters for Seniors: The bottom line
Medicare is making it more difficult for folks who want help purchasing a scooter today. One of our community members “Dennis” has this to say about Medicare reimbursement for scooters; “Medicare rarely pays for senior scooters. We submit claims all the time and they always deny them. You will end up paying out of pocket for a senior scooter.”
So the best thing you can do today if you feel you're eligible for Medicare assistance is to follow the new strict guidelines and work with a sanctioned DME provider in your local community.
If you have tips to share, or would like to comment on this issue (or other mobility issues) give us a shout in the comments below. If you're considering buying a scooter, make sure you read The Top 10 Questions to Ask When Evaluating Scooters for Seniors.