Jack's Blog on Medicare Plan Choices

If you’re struggling with mobility issues, a motorized scooter (also known as a power-operated vehicle or POV) could significantly improve your quality of life. But how does Medicare coverage work for these devices? Let’s break it down.

 Medicare Part B Coverage

Medicare Part B can cover motorized scooters under specific conditions. Here’s what you need to know:

Coverage Requirements

1. Your doctor must certify that you need the scooter for medical reasons.

2. You must have limited mobility and be unable to perform daily activities even with a cane, walker, or manual wheelchair.

3. You must be able to safely operate the scooter.

4. Your home should be able to accommodate the scooter.

 Costs

If your scooter is approved for coverage:

– Medicare typically covers 80% of the approved amount.

– You’re responsible for the remaining 20% plus any applicable Part B deductible.

 Process

To get your scooter covered:

1. You’ll need a face-to-face examination with your doctor.

2. Your doctor must provide a written prescription.

3. The scooter must be provided by a Medicare-approved supplier.

 Medicare Advantage Plans (Medicare Part C)

If you have a Medicare Advantage plan, here’s what you should know:

– These plans are required to cover at least what Original Medicare does, so they should cover motorized scooters under similar conditions.

– However, specific coverage, costs, and requirements may vary by plan.

It’s crucial to check with your specific Medicare Advantage plan provider for details on their coverage of motorized scooters, as terms can differ from Original Medicare.

 Conclusion

While Medicare can provide significant help in covering the cost of a motorized scooter, it’s essential to understand the requirements and process. Always consult with your healthcare provider and Medicare representative to ensure you meet all necessary criteria before proceeding with a purchase.

Remember, the goal is to improve your mobility and quality of life. If a motorized scooter can help you achieve that, it’s worth exploring your Medicare coverage options.

But wait.  What about Medicare Advantage Plans?

Medicare Advantage plans (also known as Medicare Part C) and their coverage of scooters can be summarized as follows:

1. Basic coverage: Medicare Advantage plans are required by law to cover at least what Original Medicare (Part A and Part B) covers. This means they should cover motorized scooters under similar conditions as Medicare Part B.
2. Potential variations: While the basic coverage is guaranteed, Medicare Advantage plans may have different:
   • Costs (copayments, coinsurance, deductibles)
   • Rules for how you get services (like needing a referral to see a specialist)
   • Coverage for extra services that Original Medicare doesn’t cover
3. Specific requirements: Each Medicare Advantage plan may have its own:
   • Network of approved suppliers
   • Pre-authorization process
   • Documentation requirements
4. Potential additional benefits: Some Medicare Advantage plans might offer more generous coverage for durable medical equipment like scooters, but this varies by plan.
5. Importance of checking: Because of these potential variations, it’s crucial for individuals to check with their specific Medicare Advantage plan provider for details on their coverage of motorized scooters.
6. Cost considerations: While coverage might be available, the out-of-pocket costs could differ from Original Medicare. Some plans might have lower copayments or coinsurance for durable medical equipment.
7. Annual changes: Medicare Advantage plans can change their coverage and costs each year, so it’s important to review your plan annually.

The key takeaway is that while Medicare Advantage plans must cover scooters if Original Medicare would, the specifics of that coverage can vary. It’s always best to contact your plan directly for the most accurate and up-to-date information about scooter coverage.

Here is my disclaimer.  I gather most of my information from Medicare.gov and CMS.gov and to the best of my knowledge, it is accurate.  I have also drawn from my own experience helping people get qualified for their scooter.  Please use this information as a guideline.

Before choosing an Advantage or Supplement plan, ensure you have a thorough understanding of Medicare itself. When it’s time to explore your options, don’t fall for a sales pitch from a single company or an agent representing only one provider.

At “More Plans More Choices,” I can provide you with side-by-side comparisons from various insurance carriers. More carriers plus more plans equals more choices.

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