Medicare covers mobility scooters, but only under specific conditions

Medicare Part B covers a mobility scooter (called a motorized wheelchair in Medicare's terms) if your doctor prescribes it as medically necessary and you meet the coverage rules. The scooter must be for use in your home, your doctor must document that you cannot walk the distance needed for daily activities even with a cane or walker, and you must be homebound or nearly homebound. Medicare will not cover a scooter for outdoor use only, for convenience, or because you want one.

The process starts with your doctor, not with Medicare. Your doctor must write an order stating that a scooter is medically necessary for your condition. Without that order, you have no claim. Medicare then pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent, unless you have a Medigap or Medicare Advantage plan that covers it.

Key Takeaways

  • Your doctor must write an order for the scooter and document that you cannot walk safely or far enough for daily living, even with a cane or walker.
  • Medicare covers scooters for home use only; outdoor-only scooters and those for convenience are not covered.
  • You must work with a Medicare-approved durable medical equipment (DME) supplier, not buy the scooter yourself and ask Medicare to reimburse you.
  • Medicare pays 80 percent of the approved amount after your Part B deductible; you pay 20 percent unless supplemental insurance covers it.
  • The approval process typically takes two to four weeks from the time the DME supplier submits the paperwork.

What Medicare considers medically necessary for a scooter

Medicare has a narrow definition of medical necessity for mobility scooters. You must have a condition that limits your ability to walk — such as severe arthritis, heart disease, lung disease, or neurological conditions — and your doctor must document that you cannot walk the distance needed for activities of daily living, even with a cane, walker, or other aid. "Cannot walk" means you would be at serious risk of falling, would experience severe pain, or would become dangerously short of breath.

Your condition must be expected to last at least 13 days. If your doctor thinks you will recover in a week or two, Medicare will not cover the scooter. You also must be homebound or essentially homebound — meaning you leave home only with considerable difficulty or for medical treatment. If you can leave home regularly for shopping, social activities, or work, Medicare will likely deny the claim.

Medicare does not cover scooters for outdoor use alone, even if you have a medical condition. If you can walk indoors but want a scooter for the driveway or neighborhood, that is not covered. The scooter must be for use inside your home or for getting to and from your car or mailbox as part of a homebound routine.

How to start the process with your doctor

Schedule an appointment with your primary care doctor or the specialist treating your condition. Bring a list of your mobility problems — how far you can walk, what causes you to stop, whether you fall or nearly fall, how your condition affects your daily routine. Your doctor needs specific information to write a medical necessity order that Medicare will accept.

Tell your doctor you want a scooter because of your walking limitations. Do not ask for a scooter and expect your doctor to agree without seeing the need. Your doctor will examine you, review your medical history, and decide whether a scooter is the right tool for your situation. If your doctor agrees, they will write an order that includes your diagnosis, why you cannot walk the required distance, and why a scooter is necessary rather than a cane or walker.

Ask your doctor for a copy of the order. You will need it when you contact a DME supplier. If your doctor is unsure whether Medicare will cover a scooter in your case, ask them to contact Medicare or a DME supplier for guidance before writing the order. This can save you time and prevent a denial.

Working with a Medicare-approved DME supplier

You must obtain the scooter from a Medicare-approved durable medical equipment supplier, not buy it yourself. Medicare will not reimburse you for a scooter you purchase on your own, even if your doctor prescribed it. The DME supplier handles the paperwork, submits it to Medicare, and waits for approval before delivering the scooter.

To find a Medicare-approved supplier, call Medicare at 1-800-MEDICARE or visit Medicare.gov and use the supplier search tool. Enter your zip code to see which suppliers in your area carry mobility scooters. Call at least two suppliers and ask whether they accept Medicare, whether they have the model your doctor recommended in stock, and what your out-of-pocket cost will be after Medicare pays its share.

When you contact a supplier, have your doctor's order ready. The supplier will ask for your Medicare number, your doctor's contact information, and details about your condition. The supplier will then submit a Certificate of Medical Necessity (CMN) to Medicare along with your doctor's order. Medicare reviews this paperwork and either approves or denies the claim. The supplier will tell you the outcome and, if approved, when the scooter will be delivered.

What Medicare pays and what you pay

Medicare pays 80 percent of the approved amount for a mobility scooter after you have met your Part B deductible for the year. The approved amount is set by Medicare, not by the supplier's price. If a supplier charges more than the approved amount, you are responsible only for your 20 percent share of the approved amount; the supplier must write off the difference.

Your 20 percent cost-sharing applies to the approved amount. For example, if Medicare's approved amount is $1,000, Medicare pays $800 and you pay $200 (assuming you have met your deductible). If the supplier charges $1,500, you still pay only $200 — the supplier absorbs the extra $500.

If you have a Medigap policy or a Medicare Advantage plan, check your plan documents to see whether it covers the 20 percent cost-sharing for durable medical equipment. Some plans cover it fully; others cover part of it; some cover nothing. Call your plan before you order the scooter so you know your actual out-of-pocket cost.

Common reasons Medicare denies scooter claims

Medicare denies many scooter claims because the doctor's order does not include enough detail about why the person cannot walk. A vague order such as "patient has arthritis and needs a scooter" will be denied. The order must explain the specific walking distance the person can manage, what happens when they try to walk farther (pain, shortness of breath, fall risk), and why a cane or walker is not sufficient.

Claims are also denied when the person is not homebound. If you leave home regularly for activities other than medical care, Medicare will view you as not homebound and will deny the claim. If your situation has changed and you are now more mobile, tell your doctor before they write the order.

Another common reason for denial is that the scooter is for outdoor use only. Medicare covers scooters for home use. If you want a scooter primarily for the neighborhood or park, that is not covered. Some people have two scooters — one for indoors (covered by Medicare) and one for outdoors (not covered) — but Medicare will only pay for the indoor one.

What happens after Medicare approves your claim

Once Medicare approves the claim, the DME supplier will contact you to schedule delivery. The supplier typically delivers the scooter, assembles it, shows you how to operate it, and explains the warranty and maintenance. Medicare's approval is usually valid for five years, meaning you can request repairs or replacement parts during that time without a new doctor's order.

If the scooter breaks down or stops working, contact the supplier first. The supplier will repair it or, if it cannot be repaired, may replace it under Medicare's coverage. You do not pay for repairs or replacement if the scooter is still within the five-year coverage period and the breakdown is not due to misuse.

Keep your Medicare approval letter and your doctor's order in a safe place. If you move, change suppliers, or need to prove coverage to another provider, you will need these documents.

Frequently Asked Questions

Can I buy a scooter myself and have Medicare reimburse me?

No. Medicare will not reimburse you for a scooter you purchase on your own. You must work with a Medicare-approved DME supplier from the start. The supplier submits the paperwork to Medicare before you receive the scooter.

What if my doctor says I need a scooter but Medicare denies it?

Ask the DME supplier why Medicare denied the claim. Usually it is because the doctor's order lacked detail. Your doctor can write a more detailed order explaining your walking limitations, and the supplier can resubmit. You can also ask your doctor to contact Medicare directly to discuss your case.

Does Medicare cover a scooter if I use it only outdoors?

No. Medicare covers scooters for home use only. If you want a scooter for outdoor activities, that is not covered. Some people have a home scooter (covered) and a separate outdoor scooter (not covered).

How long does it take to get a scooter after Medicare approves it?

The approval process usually takes two to four weeks from the time the supplier submits the paperwork. Delivery happens within a few days after approval. Ask the supplier for a timeline when you first contact them.

What if I no longer need the scooter — can I return it?

Once Medicare pays for a scooter, it is yours to keep. You cannot return it for a refund. If your condition improves and you no longer need it, you can donate it or sell it, but Medicare will not take it back or refund its cost.