Durable Medical Equipment (DME) is equipment designed to assist with the basic needs of patients who are injured, ill, disabled or have certain medical conditions.
DME coverage predominately falls under Part B. In some cases, Part A will pay for the equipment during an inpatient stay. There are certain criteria that Medicare requires in order for patients to obtain any Durable Medical Equipment.
The equipment must provide durability so a patient can have multiple and long-term use of the equipment. It must also provide appropriate therapeutic use in the home for the medical condition in which it’s being used. Lastly, it must be deemed medically necessary by a licensed healthcare provider.
Medicare Coverage of Durable Medical Equipment
There are many different forms of Durable Medical Equipment. Based on your different healthcare needs, your provider will prescribe DME to assist with your care in the comfort of your home.
Common types of Medicare Covered DME:
- Wheelchairs & power mobility chairs
- Crutches, canes, walkers and any other walking assistance device
- Hospital beds
- Personal care aids including commodes, Hoyer lifts, dressing aids or bath chairs
- Home Oxygen equipment and supplies
- Blood glucose and monitoring strips for diabetic monitoring at home
- Some incontinence products such as disposable undergarments and catheters
- Orthotic braces including lumbar supports, cervical collars, and neural wrist splints
- CPAP devices and accessories
What DME is NOT Covered by Medicare
Any coverage for these products includes the basic model only. Any alterations, modifications or upgrades would be out of pocket expenses.
Motorized scooters are not covered by Medicare unless they’re able to be used inside the home as well as outside.
Any upgrades inside your home, such as ramps or grab bars, won’t be covered.
A good rule of thumb, if the item can only be used once, it most likely won’t be covered. An exception to this rule is if you’re receiving home health care.
Purchasing vs Renting DME Through Medicare
Keep in mind, some DME can be purchased and some can only be rented. After 13 months of renting the equipment, it’s yours to keep. With the exception of oxygen equipment. Oxygen equipment can only be rented, not purchased.
Schedule an Office Visit with your Physician
The first step in purchasing DME is to schedule an appointment with your healthcare provider. As previously stated, your physician must deem the DME requested to be medically necessary. It must be difficult for the patient to perform acts of daily living without the use of the DME at home.
Find a DME Supplier Approved by Medicare
Once you have obtained a prescription from your doctor, you then would need to find a medical supply store or company that is Medicare-approved. A good source of information if you have any questions in regards to purchasing DME is Aeroflow Healthcare.
Medicare DME Providers
If you have a Medigap policy or Standard Medicare, you can use this tool to find a local DME provider.
Suppliers for DME Under Original Medicare
In most locations around the states, Medicare only works with approved contracted suppliers through the DMEPOS Competitive Bidding Program. Any equipment from a supplier that is not contracted through this program will not be covered.
Make sure to check with the supplier that they are an approved contractor before purchasing and equipment through them. If your outside these locations, you can use any supplier that participates in Medicare. To find suppliers in any area, click here.
Suppliers for DME Under Medicare Advantage
With certain Medicare Advantage policies, a prior authorization may be needed before obtaining any DME. Keep in mind, these plans commonly have their own set of in-network vendors you will be required to use. It’s recommended to check with your insurance carrier prior to obtaining any home equipment.
Medicare Special Requirements for Durable Medical Equipment
Since some equipment is more expensive than others, it has special requirements.
For example, in order to get a wheelchair, the doctor must specify that it’s extremely difficult for the patient to get around in their own home.
Another special requirement is the patient must have issues with daily activities like bathing and/or getting dressed.
To get a power wheelchair, the doctor must specify on the prescription that the patient can’t safely use a manual wheelchair.
The doctor must also note the date of the patients’ office visit and provide his expert opinion regarding if you can safely use it or not.
The power wheelchair must also be ordered with 45 days of the prescription.
Requirements for Medicare to Replace DME
Durable Medical Equipment must be at least five years old and in your care for the entirety of its life in order to have Medicare replace it. If your equipment is simply worn down, the supplier should be able to provide you with the guidelines to have it replaced.
How Does Medicare Pay for DME
Part A covers DME as long as the patient is in a hospital or skilled nursing facility setting. If you don’t have a supplement plan, the patient will be responsible for the Part A deductible of $1,364, unless it’s already been met that year.
Most other scenarios will fall under Part B. Once the patient pays the $185 Part B deductible, Medicare covers 80% of the cost. If the Medicare beneficiary has a supplement plan, the remaining 20% will be billed to the supplement carrier.
Get Help with Out of Pocket Costs for Durable Medical Equipment
Part B only covers 80% of the cost of patients DME. As a result, the beneficiary is responsible for the 20% left remaining. Durable Medical Equipment can be pricey within itself. Which means your out of pocket costs can escalate quickly.
Enrolling in a Medicare Supplement plan can help even out these costs. Leaving the beneficiary with the right home equipment they need, without breaking the bank. Fill out the online form or call one of our insurance agents today for more information on ways to save!