ORIGINAL MEDICARE
Durable Medical Equipment, often referred to as DME, is equipment designed to assist with the basic needs for those whom are injured, ill, disabled or have certain medical conditions. DME is designed to provide therapeutic benefits for patients based on their individual healthcare needs.
DME coverage predominately falls under your Medicare Part B. In some cases Medicare Part A will cover DME. However, this is only while in enrolled in a home health program or a hospital setting. There is certain criteria that Medicare requires in order for patients to obtain any DME:
- First, it must provide durability so a patient can have multiple and long-term use of the equipment.
- Secondly, it must 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.
Durable Medical Equipment Covered by Medicare
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. The most common types of DME are:
- Wheelchairs
- Crutches, canes, walkers and any other walking assistance device.
- Hospital beds
- Personal Care aids including commodes, hoyer lifts, dressing aids or bath chairs
- Prosthetics
- 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.
Again, Medicare Part B will cover most DME products. The coverage for these products include the basic model only. Any alterations would be considered out of pocket.
Out of Pocket Costs:
- Expensive upgrades
- Motorized scooters for use out of home
- Home ramps or grab bars
- One time use items such as latex gloves or face masks
How to Obtain Durable Medical Equipment
The first step in obtaining DME is to schedule an appointment with your healthcare provider. As previously stated, your physician must deem the DME requested to be medically necessary. Therefore, it must be difficult for the patient to perform acts of daily living without the use of the DME at home.
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 obtaining DME is Aeroflow Healthcare.
Medicare Coverage and DME
All people who currently have Medicare Part B are eligible for Durable Medical Equipment without exception. Medicare Part A covers DME in some cases cases. However, this is only if the beneficiary is currently hospitalized or eligible for home health care.
If a patient requires home medical supplies based upon an injury or illness while hospitalized, they are then covered under their Medicare Part A insurance.
With the Home Health Care Benefit, Medicare Part A covers those beneficiaries that are incapable of leaving their home residences and require skilled nursing care.
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. Furthermore, you should check with your insurance carrier prior to obtaining any home equipment.
How to Get Help with Medicare Costs for Durable Medicare Equipment
Whether Medicare Part A or Part B, insurance coverage only covers 80%. As a result, the beneficiary is responsible for the 20% left remaining. Durable Medical Equipment can be pricey within itself. Which means your OOP 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!