How Medicare Covers Durable Medical Equipment

Crutch-Wheelchair-Disability

Does Medicare Cover Medical Equipment at Home?

Once you are covered by Medicare Part B (medical coverage), it’s important to understand all your options when it comes to medical supplies and equipment at home. Part B doesn’t cover common medical supplies such as like toilet seats, bandages and gauze, but it does cover other supplies defined as durable medical equipment, also known as DME.

What is considered DME?

It is defined as medical equipment prescribed by your doctor for use in the home that can withstand repeated use, is used for a medical reason, and has an expected lifetime of at least three years. DME can only be prescribed to you by your doctor, and—depending on the type of equipment—you may be required to either rent it or buy it through Medicare.

Some eligible items include:

  • Blood sugar monitors
  • Blood sugar (glucose) test strips
  • Canes
  • Commode chairs
  • CPM machine
  • Crutches
  • Hospital beds
  • Infusion pumps and supplies
  • Manual wheelchairs and power mobility devices
  • Nebulizers and nebulizer medications
  • Oxygen equipment and accessories
  • Patient lifts
  • Sleep apnea and CPAP devices and accessories
  • Suction pumps
  • Traction equipment
  • Walkers

Medicare will only cover your DME if your doctors are enrolled in Medicare. So your first step is to ask if they are enrolled. To be enrolled in Medicare, there are strict standards doctors must meet. If they are not enrolled in Medicare, your DME will not be covered. It’s also important to ask your DME suppliers if they participate in Medicare. For the lowest costs, you will want to choose suppliers that are participating. If they are participating, they will accept the Medicare-approved cost for the equipment (also known as assignment) and will not overcharge you. If suppliers don’t accept assignment, there’s no limit on the amount they can charge you. Be aware that some suppliers may be enrolled in Medicare but aren’t considered “participating.”

To find Medicare-participating suppliers in your area, visit the Medicare Supplier Directory.


How does my Medicare Supplement Plan work with this?

How Medicare covers the different pieces of DME varies depending on the piece of equipment. Your Medigap Plan will help to cover all if not part of the 20% of the Part B Medicare-approved costs. Knowing what “letter plan” you have along with calling your provider will help you determine if you have to pay and how much with each piece of DME.


What if I have a Medicare Advantage Plan?

Medicare Advantage plans (like HMOs or PPOs) must cover at least the same level of coverage as Original Medicare. But as with most Advantage Plan coverage, your doctor and DME supplier must be in-network to be covered. How your Advantage plan covers each piece of equipment will vary—primarily in whether they cover it as a purchase or a rental. If you need DME and are in a Medicare Advantage plan, your first step would be to contact your plan provider and find out your options. Ask specifically if the equipment you need is covered and how much it will cost you.

Need more guidance on this topic?

We are here to help navigate you through the Medicare maze, customizing a plan to your situation that will get you where you need to be today while preparing for tomorrow. Griffin Insurance Solutions is an independent agency that offers plans from 15 different insurers. We understand that each client is a unique individual, and we want to help you find the best plan and the right insurer. We ensure that your options remain flexible so you can use the providers and doctors of your choice. We’ll happily address your questions and concerns and help you find the best plan for you. Contact us today for in-person appointment by email or phone at 919-704-6147 or 800-774-1434.


Sources:
https://www.medicare.gov/Pubs/pdf/10110.pdf

Annual Wellness Visit


https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf