Is There Medicare Coverage of Durable Medical Equipment and Other Devices?
When it comes to a beneficiary’s medical treatment, medicine and hospital treatment can only go so far. They may need some assistance at home after receiving care at a facility. Or, maybe they never needed to go to the hospital and just need additional support. Durable medical equipment (DME) may be able to help.
Durable medical equipment is medically necessary medical gear prescribed by a primary care physician. This category of tools and gear is fairly broad and includes much of the supportive equipment that seniors may need.
Does DME Qualify for Medicare Coverage?
To qualify for Medicare coverage, the DME must be ordered by a doctor. It must also meet a series of other qualifiers. To be covered, DME must be durable, meaning it can be usable multiple times and have a lifetime of around three years. It must be useful for a medical reason; DME wouldn’t usually be useful to a healthy person. Additionally, the beneficiary must plan to use the equipment in their home.
How Is It Covered by Medicare?
If a piece of DME fits those criteria, it should qualify for Medicare. A beneficiary’s equipment coverage comes from Medicare Part B or their Medicare Advantage plan.
For Medicare to cover their equipment, the supplier must accept assignment for DME claims. When looking for DME to purchase, beneficiaries should check if the supplier is a “participating supplier” with Medicare, because if they are, they must accept assignment. If they are not a “participating supplier,” they can turn down a beneficiary’s request and charge them anything they want. Beneficiaries should also ensure that both their doctor and the supplier are enrolled in Medicare. If they are not, that may mean they do not meet Medicare’s strict standards to qualify or do not want to accept Medicare. As a result, Medicare will not cover their DME.
With Medicare coverage, beneficiaries will likely be expected to pay 20 percent of the Medicare-approved amount, as well as their Part B deductible, for their DME. If beneficiaries have a Medicare Advantage plan, it will define the out-of-pocket costs of their DME.
In some areas, Medicare will hold a Competitive Bidding Program, where companies make bids to supply the DME needs of Medicare-enrollees. Medicare will base the price of the equipment off these bids. This program is not everywhere in the United States, only in competitive bidding areas. Medicare thoroughly vets each company before accepting a bid.
The Different Types of DME
Beneficiaries will probably wonder what gear is generally considered DME. Many pieces of DME are mobility aids, such as support canes (not white or “probing” canes for the blind), crutches, walkers, or wheelchairs (manual and powered). Others are comfort and assisted-living devices, like hospital beds or commode chairs. DME can also include sleep apnea machines, blood sugar monitors, and patient lifts (used to move mobility-impaired individuals into a wheelchair). These lists are not exhaustive, beneficiaries should check with their doctor to see if what their need is considered a DME.
In some instances, beneficiaries will not be able to purchase this type of equipment, only rent. This choice is usually made by Medicare or the insurance company, in the case of Medicare Advantage plans. Sometimes, they may have to rent the DME for a period of time, and then they can take ownership of it afterward. Should a Medicare-covered item break or require repairs while they are renting it, they will not need to pay to replace it. Beneficiaries will be expected to pay 20 percent of the rental fee, however. If they own the equipment and it is covered by Medicare, Medicare will cover 80 percent of any approved repairs or maintenance while beneficiaries cover the rest.
DME is essential for many seniors on Medicare. It can give them noticeable, significant assistance in their lives. Since these pieces of equipment can often be prohibitively expensive, Medicare’s coverage can make all the difference in whether someone is able to attain these medically-necessary tools.
Centers for Medicare & Medicaid Services — Medicare Coverage of Durable Medical Equipment and Other Devices
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