How to Get an Electric Scooter Through Medicaid

For individuals with mobility limitations, electric scooters (also called power scooters or mobility scooters) provide essential independence and improved quality of life. Understanding how to obtain a mobility scooter through Medicare and Medicaid can make these vital devices accessible and affordable. This comprehensive guide explains coverage requirements, eligibility criteria, application processes, costs, and state-specific variations for obtaining electric scooters through government healthcare programs in 2024-2025.

Understanding Medicare vs. Medicaid Coverage

Medicare Coverage Overview

Programs that cover: Medicare Part B and Medicare Advantage plans cover mobility scooters, also known as power scooters, as durable medical equipment (DME).

DME classification: Mobility scooters qualify as DME because they:

• Are prescribed by a doctor for medical purposes


• Can withstand repeated use


• Are primarily used for medical purposes (not recreational)


• Are appropriate for use in the home

Medicare Advantage: Medicare Advantage plans (Part C) typically cover the same DME benefits as Original Medicare, though specific procedures and approved suppliers may vary by plan.

Medicaid Coverage Overview

State variation: Medical assistive equipment like power wheelchairs or scooters are covered as Durable Medical Equipment under Medicaid for patients who meet the full Medicaid eligibility criteria and pass the medical necessity assessment.

Important difference: Coverage for electric scooters varies based on individual state regulations. Some states offer full or partial coverage for electric scooters, while others may not cover them at all. Each state's Medicaid program establishes its own DME coverage policies within federal guidelines.

Cost sharing: If you qualify for Medicaid, you typically have no or very low cost sharing for your healthcare needs, so you may well be eligible for a free scooter with little to no out-of-pocket expense.

Dual Medicare-Medicaid Coverage

Dual eligible benefits: State Medicaid can cover what Medicare won't if you qualify financially, and many people don't realize they can have both Medicare and Medicaid simultaneously.

Coverage coordination: When you have both:

• Medicare pays first as primary insurance


• Medicaid may cover Medicare deductibles, copayments, and items Medicare doesn't cover


• Combined coverage often results in minimal or zero out-of-pocket costs

Medicare Eligibility Requirements

Medical Necessity Criteria

Doctor prescription required: Your doctor must deem it medically necessary and prescribe the scooter, certifying that you require it to complete daily activities, have limited mobility due to a health condition, and can safely operate the scooter.

Specific medical necessity criteria:

• Mobility limitation: You have a condition that significantly impairs your ability to participate in mobility-related activities of daily living (MRADLs) in your home


• Home use justification: The scooter must be necessary for use within your home, not just for outdoor or recreational use


• Safe operation: You must be able to safely operate the scooter or have a caregiver available to assist


• Physical/mental capability: You have the physical and mental capability to safely use the scooter


• Home accommodation: Your home can accommodate the scooter (doorways, turning radius, etc.)

Important limitation: Medicare will not cover an electric scooter if it is only needed for outdoor use or recreational purposes. The scooter must be essential for routine daily activities and mobility within the home.

Face-to-Face Examination Requirement

In-person visit: Before prescribing a mobility scooter, your doctor must conduct a face-to-face examination within the 6 months prior to the scooter prescription.

Documentation: The doctor must document:

• Your mobility limitations


• How the scooter will improve your daily functioning


• Why less expensive mobility aids (canes, walkers, manual wheelchairs) are insufficient


• That you can safely operate the scooter

Why Other Mobility Aids Are Insufficient

Progressive qualification: Medicare requires demonstration that simpler, less expensive mobility aids are inadequate before approving power scooters.

Justification examples:

• Canes/walkers insufficient due to severe balance issues or upper body weakness


• Manual wheelchair impractical due to inability to self-propel (arm strength, stamina, or coordination issues)


• Distance limitations in home requiring powered assistance

Medicare Costs and Coverage Amounts

Deductible and Coinsurance

Part B deductible: Medicare will not pay for your wheelchair until you've met your Part B deductible ($257 in 2025, updated annually).

20% coinsurance: You must also pay 20% of the Medicare-approved amount for the particular mobility device after meeting your deductible.

Cost example: If Medicare approves a $3,000 scooter:

1. You pay $257 deductible (if not yet met)


2. Medicare pays 80% of remaining $2,743 = $2,194.40


3. You pay 20% of $2,743 = $548.60


4. Total out-of-pocket: $805.60 ($257 + $548.60)

Rental vs. Purchase

Initial rental period: Medicare typically begins by renting scooters rather than purchasing them outright. You'll pay the 20% coinsurance on monthly rental fees.

13-month capped rental: After 13 months of continuous rental payments, ownership typically transfers to you at no additional cost.

Rent-to-own benefit: This approach protects Medicare (and you) from paying for equipment that may not work long-term for your needs. If the scooter doesn't work out in the first few months, it can be exchanged.

Medigap Supplemental Coverage

Supplemental insurance: Medicare Supplement Insurance (Medigap) policies may cover the 20% coinsurance and Part B deductible, potentially reducing your out-of-pocket costs to zero.

Check your plan: Review your Medigap plan documents to understand DME coverage specifics.

2025 Prior Authorization Changes

New Approval Timeline

Faster processing: As of January 1, 2025, the Centers for Medicare & Medicaid Services reduced the time to approve a standard prior authorization request to no more than 7 calendar days (down from 14 days).

Expedited requests: Expedited prior authorization requests must be processed within 72 hours when medical urgency is documented.

Benefit: This change significantly reduces wait times for mobility equipment, helping beneficiaries receive needed devices faster.

Prior Authorization Requirements

What is prior authorization? Before supplying the scooter, your DME supplier must obtain Medicare's approval (prior authorization) confirming medical necessity and coverage.

Required documentation:

• Doctor's prescription and detailed written order


• Face-to-face examination documentation


• Medical records supporting mobility limitations


• Justification for why other mobility aids are insufficient


• Proof of safe operation capability

Supplier responsibility: The DME supplier typically handles the prior authorization paperwork, submitting documentation to Medicare on your behalf.

Medicaid Eligibility Requirements

Financial Eligibility

Income limits: Medicaid eligibility is based on income and varies by state. Most states set limits as a percentage of the Federal Poverty Level (FPL), typically 138% FPL for adults under Affordable Care Act expansion.

Asset limits: Many states also consider assets (savings, property, vehicles) when determining eligibility, though limits vary widely.

Special populations: Certain populations may qualify with higher income limits:

• Pregnant women


• Children


• Elderly individuals (65+)


• Individuals with disabilities

Medical Eligibility for Scooter Coverage

Medical necessity assessment: Like Medicare, Medicaid requires demonstration of medical necessity through:

• Doctor's prescription and examination


• Documentation of mobility impairment


• Justification for powered mobility over manual alternatives


• Proof that scooter enables essential daily activities

State-by-State Coverage Variation

Full coverage states: Some states provide comprehensive Medicaid coverage for power scooters with minimal cost-sharing when medical necessity is established.

Limited coverage states: Other states may:

• Cover only manual wheelchairs, not power scooters


• Require prior authorization with strict criteria


• Impose annual caps on DME spending


• Provide coverage only for specific medical conditions

No coverage states: Some states may not cover electric scooters at all through Medicaid, though manual wheelchairs may be covered.

Check your state: Contact your state Medicaid office or visit your state's Medicaid website to understand specific coverage policies for power mobility devices.

Step-by-Step Application Process

Step 1: Consult Your Doctor

1. Schedule appointment: Book a face-to-face examination with your primary care physician or specialist (physiatrist, neurologist, orthopedist)


2. Discuss mobility needs: Explain your mobility limitations and how they affect daily activities in your home


3. Assessment: Doctor will evaluate your condition, mobility limitations, and need for powered assistance


4. Prescription: If appropriate, doctor will write a prescription for a power mobility scooter

Step 2: Obtain Detailed Documentation

Written order: Your doctor must provide a detailed written order (DWO) that includes:

• Diagnosis causing mobility limitation


• Description of mobility limitations


• Specific activities of daily living affected


• Why a power scooter is medically necessary


• Why simpler mobility aids are insufficient


• Confirmation you can safely operate the scooter


• Confirmation your home can accommodate the device

Medical records: Supporting medical records documenting your condition and mobility limitations should be available for review.

Step 3: Select Medicare/Medicaid-Approved DME Supplier

Find approved suppliers: Contact Medicare-approved DME suppliers in your area. Medicare.gov provides a supplier directory.

Supplier qualifications: Ensure the supplier:

• Is enrolled in Medicare/Medicaid


• Is accredited by Medicare-approved accrediting organization


• Has experience with mobility scooters and prior authorization


• Accepts Medicare/Medicaid assignment (agrees to accept approved amount as full payment)

Get recommendations: Ask your doctor's office for recommendations of reputable DME suppliers they work with regularly.

Step 4: Supplier Assessment and Selection

1. Home assessment: The supplier may visit your home to assess doorway widths, turning radius requirements, and appropriate scooter specifications


2. Scooter selection: Based on your doctor's prescription and home assessment, the supplier will recommend appropriate scooter models


3. Try before you buy: Test different models to ensure comfort and proper operation


4. Specifications: Finalize scooter specifications including weight capacity, seat size, turning radius, and features

Step 5: Prior Authorization Submission

1. Supplier compiles documentation: The DME supplier gathers all required documentation including prescription, medical records, and their assessment notes


2. Submit to Medicare/Medicaid: Supplier submits prior authorization request with all supporting documentation


3. Wait for approval: Standard requests now processed within 7 days (as of 2025); expedited requests within 72 hours


4. Address denials: If denied, your doctor and supplier can provide additional documentation or appeal the decision

Step 6: Delivery and Training

1. Schedule delivery: Once approved, schedule scooter delivery and setup


2. Setup and adjustment: Supplier will deliver, assemble, and adjust scooter for your specific needs


3. Training: Supplier must provide thorough training on safe operation, charging, and maintenance


4. Documentation: Sign delivery receipt and keep all paperwork for records

Step 7: Ongoing Maintenance and Repairs

Covered repairs: Medicare/Medicaid typically covers necessary repairs and maintenance for covered equipment.

Contact supplier: For issues or repairs, contact your original DME supplier first. They usually handle warranty repairs and Medicare-covered service.

Replacement: After the reasonable useful lifetime (typically 5 years for scooters), you can request a replacement if still medically necessary.

Common Reasons for Denial and How to Avoid Them

Insufficient Medical Documentation

Problem: Application lacks detailed documentation of mobility limitations or medical necessity.

Solution: Ensure your doctor provides comprehensive written order addressing all Medicare criteria. Include specific examples of daily activities impaired by mobility limitations.

Scooter Only Needed for Outdoor Use

Problem: Documentation suggests scooter is primarily for outdoor activities, shopping, or recreation.

Solution: Emphasize home mobility needs. Describe how the scooter enables essential activities within your home (moving between rooms, accessing bathroom, reaching kitchen, etc.).

Lack of Face-to-Face Examination

Problem: Required in-person examination not conducted or not documented within required timeframe.

Solution: Ensure face-to-face examination occurs within 6 months before prescription and is properly documented in medical records.

Simpler Mobility Aids Not Ruled Out

Problem: Documentation doesn't adequately explain why canes, walkers, or manual wheelchairs are insufficient.

Solution: Doctor should document specific reasons why less complex aids won't work (e.g., "Patient cannot self-propel manual wheelchair due to severe arthritis in both shoulders and hands").

Using Non-Approved Supplier

Problem: Supplier is not enrolled in Medicare/Medicaid or not properly accredited.

Solution: Verify supplier's Medicare enrollment and accreditation status before beginning the application process.

Appeals Process if Denied

Medicare Appeal Levels

Level 1 - Redetermination: Request within 120 days of initial denial. Submit additional documentation addressing denial reasons. Decision within 60 days.

Level 2 - Reconsideration: If Level 1 denied, request reconsideration within 180 days. Independent review by Qualified Independent Contractor (QIC). Decision within 60 days.

Level 3 - Administrative Law Judge: Request hearing within 60 days if claim value exceeds $180 (2024 threshold). Hearing conducted by Administrative Law Judge.

Level 4 - Medicare Appeals Council: Request council review within 60 days of unfavorable ALJ decision.

Level 5 - Federal Court: File in federal district court within 60 days if claim value exceeds $1,850 (2024 threshold).

Appeal Success Tips

• Act quickly: Don't miss appeal deadlines


• Understand denial reason: Carefully read denial explanation


• Provide new evidence: Submit additional documentation addressing specific denial reasons


• Doctor support: Have your doctor write detailed letter supporting medical necessity


• Get help: Consider assistance from Medicare advocate or attorney for higher appeal levels

Alternative Funding Options

If Medicare/Medicaid denies coverage or you don't qualify, consider these alternatives:

Medicaid Waiver Programs

Home and Community-Based Services (HCBS) waivers: Many states offer waiver programs that may cover mobility equipment not covered under standard Medicaid.

Eligibility: Often targets individuals who would otherwise require nursing home care. May have income limits higher than standard Medicaid.

Charitable Organizations

• United Way: Some local chapters have medical equipment loan programs


• Lions Clubs: May assist with mobility equipment


• Local churches and faith organizations: Often have benevolence funds for medical needs


• Disability advocacy organizations: State and local disability organizations sometimes have equipment programs

Financing and Payment Plans

DME supplier financing: Many suppliers offer payment plans allowing you to spread costs over 12-36 months.

Medical credit cards: CareCredit and similar programs offer interest-free periods for medical expenses.

Used Equipment and Donation Programs

Medical equipment exchanges: Some communities have programs where gently used medical equipment is donated and redistributed.

Online marketplaces: Facebook Marketplace, Craigslist, and eBay often have used scooters at reduced prices (ensure equipment is safe and functional).

Types of Scooters Typically Covered

Standard Mobility Scooters

Three-wheel scooters: Compact design for indoor use, tighter turning radius, typically covered by Medicare/Medicaid when medically necessary.

Four-wheel scooters: More stable, better for outdoor use but still functional indoors, commonly approved models.

Heavy-Duty Scooters

Bariatric scooters: Higher weight capacities (400-600 lbs) for larger individuals. Medicare/Medicaid covers when medical documentation supports need for higher capacity.

Travel/Portable Scooters

Coverage uncertainty: Lightweight travel scooters that disassemble for transport may or may not be covered, as they're sometimes viewed as primarily for outdoor/recreational use.

What's NOT Covered

• Recreational electric scooters: Stand-up e-scooters for recreation/transportation (not mobility aids)


• Luxury features: Premium upgrades not medically necessary (deluxe seats, enhanced electronics, etc.)


• Second scooter: Generally only one scooter covered at a time unless medical documentation justifies multiple units

State-Specific Medicaid Resources

Contact information for researching your state's Medicaid DME coverage:

• State Medicaid website: Search "[Your State] Medicaid DME coverage"


• State Medicaid phone line: Call your state's Medicaid customer service


• Area Agency on Aging: Local agencies often help navigate Medicare/Medicaid benefits


• SHIP (State Health Insurance Assistance Program): Free Medicare counseling in every state


• Disability Rights organizations: State-specific disability advocacy groups understand local policies

Conclusion

Obtaining an electric mobility scooter through Medicare or Medicaid requires understanding eligibility criteria, navigating documentation requirements, and working with approved suppliers, but the programs can make essential mobility equipment accessible and affordable for those who qualify. With Medicare covering 80% of costs after deductible and Medicaid potentially covering expenses with minimal cost-sharing, these programs provide vital support for individuals with mobility limitations.

Key takeaways for getting scooters through Medicare/Medicaid in 2024-2025:

• Medicare coverage: Part B and Medicare Advantage cover scooters as DME


• Medical necessity: Doctor must prescribe and document need for home mobility


• Medicare costs: $257 deductible (2025) plus 20% coinsurance after approval


• 2025 change: Prior authorization now processed within 7 days (down from 14)


• Home use requirement: Must be necessary for mobility within home, not just outdoor use


• Face-to-face exam: Required within 6 months before prescription


• Medicaid variation: Coverage varies by state; some offer full coverage with minimal cost-sharing


• Dual eligible: Having both Medicare and Medicaid often results in minimal out-of-pocket costs


• Approved suppliers: Must use Medicare/Medicaid-enrolled, accredited DME suppliers


• Appeals available: Five levels of appeal if initially denied


• Alternative funding: Waiver programs, charities, and financing available if denied

By understanding requirements, working closely with your doctor, choosing reputable suppliers, and providing thorough documentation, you can successfully navigate the Medicare and Medicaid processes to obtain a mobility scooter that enhances your independence and quality of life in 2024-2025. Don't hesitate to seek assistance from Medicare advocates, Area Agencies on Aging, or SHIP counselors who can provide free guidance throughout the application process.