ORIGINAL MEDICARE
Medicare covers Durable Medical Equipment when a patient has a medical need and a doctor writes a prescription.
Durable Medical Equipment (DME) is equipment that can assist with the basic needs of patients 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 specific criteria that Medicare requires patients to obtain any Durable Medical Equipment.
The equipment must provide durability so a patient can have multiple and long-term use. It must also provide appropriate therapeutic use in the home for the medical condition.
Lastly, it must be medically necessary by a 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.
Medicare requires that Durable Medical Equipment be an item you use repeatedly, and only you use
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
- Prosthetics
- 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.
Medicare does not cover motorized scooters unless they’re 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 is for one-time use, 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 you can buy and others you can rent. After 13 months of renting the equipment, it’s yours to keep.
Except for oxygen equipment, You can’t buy oxygen equipment; renting is the only option.
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 a prescription from your doctor, you then need to find a medical supply store or company that is Medicare approves. 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. The Competitive Acquisition Ombudsman reviews complaints about DME suppliers in Competitive Bidding Areas.
When you have an issue, inquiry, or complaint, contact the Competitive Acquisition Ombudsman for a resolution.
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 doesn’t accept Medicare will leave you responsible for 100% of the cost.
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 specific Medicare Advantage policies, prior authorization requirements may exist before obtaining any DME. Keep in mind; these plans have in-network vendors you must use. Check with your insurance carrier before getting any home equipment.
Medicare Special Requirements for Durable Medical Equipment
For a patient to have their powered wheelchair approved by Medicare, they must order it within 45 days of receiving the prescription
Since some equipment is more expensive than others, it has unique requirements.
For example, to get a wheelchair, the doctor must specify that it’s challenging for the patient to get around in their own home.
Another unique requirement is the patient must have issues with daily activities like bathing and dressing.
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 order must happen 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 to have Medicare replace it. If your equipment has damage, the supplier has replacement guidelines.
How Does Medicare Pay for DME
Part A covers DME as long as the patient is in a hospital or skilled nursing facility setting. Without a supplement plan, the patient pays the Part A deductible of $1,364; unless you already met the deductible.
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% goes to the supplement carrier.
Get Help with Out of Pocket Costs for Durable Medical Equipment
Part B only covers 80% of the cost of a patient’s DME. So, the beneficiary pays the 20% left remaining.
Durable Medical Equipment can be pricey within itself. So, your out of pocket costs can escalate quickly.
Enrolling in a Medicare Supplement plan can help out with costs.
Supplements ensure the right home equipment you 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!
Hello. Medicare paid for a rollator in September for my elderly mother. Since then she has fell twice and has limited mobility and uses a wheel chair at Rehab. Will Medicare allow a wheelchair since they just bought the walker?
Hi Karen! It’s really a case by case scenario. However, I would think that as long as your doctor finds it medically necessary, Medicare should help cover the cost of a wheelchair. We have great FAQ content on Medicare-approved wheelchairs and mobility scooters that should help you understand the approval process. If covered, it would fall under Part B, leaving your mom responsible for the 20% coinsurance. However, if she has a Medigap plan, that coinsurance will be covered. The only out of pocket expense she might have to pay is the Part B deductible of $198 unless she has Plan F. If she has Plan F, that deductible would also be covered. Hopefully, this helps! Don’t hesitate to reach out with any more questions.
The walker that I’ve been approved for sits too low and has small wheels. The supplier said I have no choices but that one !! Is there any way to chose and pay the difference ?
Hi Donna! This is a tough one. If you’re renting the equipment, Medicare makes monthly payments for use of the equipment to the supplier. So, that may be why they don’t want to take the walker back. Ideally, if they do not have the appropriate size walker for you, they should take it back. Then you and/or your doctor would find another supplier near you that does have the appropriate size walker for your needs. Have you talked to your doctor about this issue? I would recommend you call your doctor that prescribed your walker. You can also call 1-800-MEDICARE to find out how to replace your walker. Between Medicare & your doctor, you should be able to get this issue resolved.
Hello, I have a patient here that have a medicare health insurance part A and part B. Asking if she have any DME coverage. What are the steps she needs to do to get all information and process to get DME?
Hi Lady! Yes, if your patient has Part B, then she has coverage for DME. Part B will cover 80% of her DME costs. The other 20% will be her responsibility to pay unless she has a Medigap plan to cover it. To get the process started for DME, she would need to speak to her doctor to get a prescription for the DME.
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.