Does Medical Insurance Cover Mobility Scooters?

Mobility scooters can be a great way to help people with mobility issues stay independent and active. 

They can make it easier to get around, run errands, and participate in daily activities. 

However, purchasing a mobility scooter can be a significant financial investment. 

Many people wonder if their medical insurance will cover the cost of a mobility scooter.

The answer to this question is not straightforward, as it depends on your specific insurance plan and the reason for needing a mobility scooter. 

In general, medical insurance will cover mobility scooters if they are deemed medically necessary. 

This means that if a doctor or other healthcare professional has prescribed a mobility scooter for you, your insurance company will likely cover at least some of the cost. 

However, insurance companies may have different criteria for what constitutes “medically necessary,” and they may require a certain level of documentation to prove that a mobility scooter is needed.

It’s also important to note that Medicare and Medicaid coverage may vary by state and some plans don’t cover mobility scooters at all. 

It’s always best to check with your specific insurance provider and find out what is covered under your plan.

In this article, we will dive deeper into what medical insurance covers when it comes to mobility scooters and how to determine if your specific plan will help pay for one. 

Key Takeaways:

  • Medical insurance may cover the cost of a mobility scooter if it is deemed medically necessary.
  • Insurance companies may have different criteria for what constitutes “medically necessary” and will require documentation to prove a mobility scooter is needed.
  • The process for getting coverage may include a doctor’s appointment, tests to verify your limited physical condition, and documentation from the doctor and physical therapist, alongside a survey of your home to determine its suitability for the device
  • Insurers usually cover only 80% of the cost of mobility aids if approved
  • The out-of-pocket cost after being approved can range from $160 to $400 depending on the unit you chose
  • Only the most basic kinds of scooters are usually covered
  • If you don’t qualify for coverage there are other alternatives to get a discounted or even free scooter

Most Medical Insurers Will Cover a Mobility Scooter

As you surely know, medical insurance policies vary in terms of what they cover. 

Some may cover mobility scooters as durable medical equipment, while others may not. 

However, it’s nowadays pretty normal that companies offer coverage for assistive devices that disabled patients need to perform their daily activities. 

It is recommended, however, to check with your specific insurance provider to see if they cover the cost of such a device or if there are any requirements that must be met in order for coverage to be provided. 

Additionally, a physician’s prescription is usually required for the coverage of mobility scooters under medical insurance.

But usually, the qualification process is a lot more complicated than that.

Qualifying for a Mobility Scooter

Most, if not all, medical insurance providers will require you to go through a very thorough qualification process before paying for the cost of an assistive scooter.

The basic idea behind this is that they want proof that you really need the device to perform most of your basic daily at-home activities.

Yes, insurers usually only cover scooters for indoor use.

Although the qualification process can be long, and consist of a few steps, an easy way of making an idea if you would pass it is by answering the following questions:

  • Do you have mobility issues that prevent you from performing basic daily activities such as those related to hygiene and basic sustenance?
  • Do you have enough room in your house to operate a mobility scooter?
  • Can you perform the tasks mentioned above with the aid of a simpler mobility device such as a cane, a walker, or crutches?
  • Why not?

If you can back your answers to those questions with unobjectionable facts, it’s very likely that you can qualify for a powered scooter.

Process for Getting Coverage

The usual process usually takes the following steps:

  • You get a doctor’s appointment to discuss the need for a mobility aid
  • The doctor discusses the matter with you to determine your need and then schedules a series of tests to verify your limited physical condition
  • Usually, the tests are done by a physical therapist and they consist of a series of flexibility, strength, and overall mobility evaluations.
  • With the results in hand the doctor has to file a report describing, and justifying why you require a powered scooter to improve your quality of life, and no other less-complex mobility aid would work for you
  • The next step is visiting a durable medical equipment provider that works with your insurance company to discuss available units
  • The equipment dealer will then send a surveyor to your house with the goal of determining if there’s enough room to maneuver the device and properly store it
  • With this last report, everything is sent back to the insurance company and an answer is expected to be issued in around 45 days on average
  • If the result of the qualification is positive, you will then be contacted by the durable medical equipment dealer to discuss the delivery of your scooter

For a more detailed overview of these steps, I’d recommend you take a look at our article about how this works for Medicare:

Most insurers actually have very similar processes in place.

However, it’s very important that you don’t take this for granted and ask your insurer about this matter.

If you are not sure, you can also approach your doctor or even a scooter retailer since they are used to dealing with medical insurance companies, and have the incentives to help you with the qualification process.

Do Insurance Providers Cover the Full Price of a Scooter?

Sadly, insurance providers usually only cover up to 80% of a mobility scooter’s cost.

Being the remaining 20% an out-of-pocket expense for the patient.

And with scooters starting at $800 for the most basic units, this expense is not to be taken lightly.

We are talking of $160, again, for the lowest tier of devices.

For standard units that go for about $2000, the payable portion rises up to $400

This is something to consider and to budget accordingly.

Kinds of Mobility Scooters Covered

Insurance companies, in most cases, only cover the most basic models of scooters in the market.

This means that heavy-duty, all-terrain, or extended-range units are out of the question.

You can, however, get a decent, lightweight 3 or 4-wheel vehicle that will surely meet all of your needs and be easy to transport and store.

For a deeper look into the different types of scooters, you can read the following article:

Out-of-Pocket Costs After Insurance Approval

As I mentioned earlier, the direct out-of-pocket cost in most cases is 20% of the mobility aid’s value.

But things don’t usually stop there, since there might be a need to customize some aspects of the scooter, or even adapt your home for the vehicle.

Wider doors are always recommended.

Apart from this, it is always important to consider maintenance costs and possible repair expenses down the line.

Alternatives if Your Insurer Doesn’t Approve a Scooter

Getting insurance coverage for your scooter is a complicated process, and probably not everyone who needs it will eventually get it.

Luckily that’s not the end of the world, and there are many other alternatives for getting a powered scooter at a discounted price, or even for free.

Here are some of them:

  • Check with local charities and non-profit organizations: Some charities and non-profit organizations offer discounted or even free mobility scooters to those in need.
  • Look for government assistance programs: Many government programs offer financial assistance for those who need mobility equipment.
  • Shop for a used unit: Many used scooters are maintained in great condition and sold at very high discounts, if you are interested in this option I recommend you check out our guide on buying used mobility scooters.

If you want to know more about these options or get to know about other ones, I’d recommend you click on the following article:

All the claims made in this article are only for informational purposes, based on the writer’s experience and not clinical advice. You should always consult your physician or physical therapist if you have any doubts about how this applies to your specific case.