Durable medical equipment is essential for so many Medicare beneficiaries because it can help with many daily tasks. In this article, we will look at the durable medical equipment Medicare will cover and discuss the guidelines for coverage. Then, we will answer some common questions on whether Medicare helps cover durable medical equipment costs.
Medicare Guidelines for Durable Medical Equipment
Durable medical equipment may be covered under Original Medicare, which comprises of Medicare Part A and Medicare Part B.
Common examples of durable medical equipment include:
- Wheelchair
- Crutches
- Walker
- Nebulizer
- Ventilators
- Heart rate monitor
Medicare Part A covers skilled nursing facilities and inpatient care. So, inpatient devices are covered by Medicare Part A. Medicare Part B will cover Durable Medical Equipment you use at your home if your doctor decides it is medically necessary for you. The durable medical equipment must come with a prescription from a licensed health professional to be covered.
Medicare won’t cover all durable medical equipment, but it does include several items.
You’ll be able to use durable medical equipment in your home or a long-term care facility. If you must stay in a skilled nursing facility, the facility will provide you with your equipment. Medicare Part A covers skilled nursing facilities, so inpatient devices are covered.
Eligibility Criteria for Medicare to Cover Durable Medical Equipment
To qualify for Medicare coverage of durable medical equipment, there is specific criteria Medicare requires you to meet in addition to being ordered by a Medicare-approved doctor and using a Medicare accepting supplier.
To be covered by Medicare Part B, a durable medical equipment device must be:
- Used because of illness or injury
- Used at home
- Likely to last for at least three years
- Endure repeated use
- Serve a medical purpose
What Durable Medical Equipment Does Medicare Cover?
Original Medicare does not cover all durable medical equipment. Beneficiaries only receive coverage if the device is medically necessary. If you require a durable medical equipment that is not covered by Medicare, you may have to pay the full cost of the device.
Original Medicare covers the following durable medical equipment:
- Glucose monitors and strips
- Prosthetics
- Hospital beds
- Lancet devices and lancets
- Canes
- Wheelchairs & scooters
- Commode chairs
- Oxygen equipment & accessories
- Suction pumps
- Continuous Positive Airway Pressure (CPAP) devices
The list above is not all-encompassing. So, it is important to speak with your doctor before purchasing a device.
What Durable Medical Equipment is Not Covered By Medicare?
While Original Medicare covers a wide range of medical equipment, it doesn’t cover everything.
Some supplies and equipment that aren’t covered can include:
- Equipment to help you outside your home
- Equipment intended only to make things convenient and comfortable—for example, stairway elevators, air conditioners, and toilet seats
- Disposable items. For example, Medicare won’t cover incontinence pads, facemasks, or compression stockings
- Changes to your home. Modifications may include ramps or broader doors for wheelchair access
- Equipment not suitable for use in your home
Purchasing vs. Renting Durable Medical Equipment Through Medicare
Durable medical equipment can end up being quite expensive. You may find equipment available for purchase or rental. Often, Medicare pays to rent medical equipment and buy equipment when necessary.
Medicare usually will help with any repairs or replacements you may need for your device. Sometimes you need the equipment longer than a few months. Medicare may buy equipment rather than renting for situations like these.
Criteria for Medicare to Cover a Replacement for Durable Medical Equipment
To ensure Medicare coverage for replacement medical equipment, you need to order from an equipment supplier who’s Medicare-approved. Medicare will not cover a replacement just because you wish to have a new device. There are certain criteria that will warrant a replacement device to be covered by Medicare. These include:
- Lost
- Stolen
- There’s extensive damage.
- If it’s more than five years old
Durable Medical Equipment Suppliers Approved by Medicare
When you need access to durable medical equipment, you may find it hard to know where to start and what durable medical equipment supplies are available to help you with your needs.
You’ll need to get your supplies from a Medicare-approved supplier to get coverage for equipment. Medicare.gov has a durable medical equipment supplier directory to help Medicare beneficiaries search for suppliers that carry Medicare-covered equipment and supplies.
Does Medicare Advantage Cover Durable Medical Equipment?
Medicare Advantage plans must offer the same level of coverage through Medicare. But, often, you’ll find many more perks with a Medicare Advantage plan, such as extra coverage.
Medicare Advantage plans come from private insurance companies. You’ll want to confirm with your plan to ensure your equipment has coverage.
Medicare Durable Medical Equipment FAQs
How to Find Medicare Coverage for Durable Medicare Equipment
You may have questions or concerns about your Medicare coverage for Durable Medical Equipment. Medigap policies can help you with the costs of durable medical equipment items you may need. Our licensed Medicare agents can help answer any questions you may have regarding Medicare coverage of durable medical equipment. We can also look at different coverage options that may better suit your needs. Call us today for a quote. Our services are free to you! You can also compare rates online today.
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Sources:
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- Durable Medical Equipment Coverage, Medicare.gov. Accessed May 2022.
https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage - Medicare Coverage of DME and Other Services, CMS. Accessed May 2022.
https://www.medicare.gov/Pubs/pdf/11045-medicare-coverage-of-dme.pdf
My mother in law who has Alzheimer’s is currently in a long term care facility in Norfolk, VA, and is being charged $2700.00 per month for a wound vac. Can this be right? My husband is being stonewalled by the facility and Medicare says he needs a Guardianship to speak to them. He is the caregiver, has POA, and is trustee over her financial decisions. Please help!! My mother in law has Medicare Part A, Part B, and Federal BCBS as 2ndary! Need advice!
Hi Cindy! I’m so sorry you’re going through this with your mother-in-law. There is a difference between POA & Guardianship. If Medicare is stating you need guardianship, then that’s what I would recommend you do. A wound vac is considered Durable Medicare Equipment and should be covered 80% under Part B as long as her doctor deems it’s medically necessary. The remaining would be billed to her Federal BCBS plan.