Does Medicare cover driving evaulations?

A fellow caregiver asked...

My mother has been diagnosed with a memory disorder and her doctor has recommended a driving evaluation at the local rehab facility. Is this a covered benefit of Medicare? The girl told me that it would only cost us $45.00 and they would bill Medicare the rest. Thanks

Expert Answer

Medicare Part B could cover a "driving evaluation" at an outpatient rehabilitation facility if it's prescribed by a doctor. Medicare Part B covers some rehabilitation services following an injury, illness or other change in a patient's condition. These services can be physical therapy, occupational therapy, or both. The services begin with an evaluation of the patient's condition, capabilities, and needs. The evaluation and/or therapy can be provided at a therapist's office, a doctor's office, a hospital outpatient department, or a rehabilitation facility. Whoever provides the therapy must be Medicare-certified.

In your mother's case, it sounds like her doctor is sending -- to be covered by Medicare, it has to be an actual doctor prescription or referral, not just a suggestion -- her to the rehabilitation center for an occupational therapy evaluation. Actually, the name occupational therapy is a little misleading. Occupational therapists evaluate and assist people regarding their ability to perform activities of daily life, such as walking, dressing, bathing, and simple household tasks, not just tasks related to their "occupation." The daily life activities for which they can be evaluated and assisted can include driving.

However, whether Medicare Part B will cover an evaluation solely for the purposes of driving isn't a sure thing, despite what someone at the rehabilitation center told you. There are two ways of dealing with this uncertainty. First, you could have the rehabilitation center submit the paperwork to Medicare Part B, and get a yes or no answer from Medicare, before your mother has the evaluation. That way, you'll know ahead of time whether Medicare Part B will cover it and how much you'll have to pay. The other way is to have the rehabilitation center agree in writing that your mother will only owe them $45, regardless of whether or not Medicare later decides to cover the evaluation. Many Medicare-certified providers agree to this kind of arrangement if they are confident, based on their experience and on the content of the patient's referral, that Medicare will pay.