When it comes to your medical treatment, medicine and hospital treatment can only go so far. You may need some assistance at home after receiving care at a facility. Or, maybe you never needed to go to the hospital and just need additional support. Durable medical equipment (DME) may be able to help.
What is durable medical equipment? It 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 Insurance Coverage?
To qualify for Medicare insurance 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 the Medicare program. Your equipment coverage comes from Medicare Part B or your Medicare Advantage plan.
For the Medicare program to cover your equipment, the supplier must accept assignment for DME claims. When looking for DME to purchase, you should check if the supplier is a “participating supplier” with Medicare, because if they are, they must accept assignment. If they’re not a “participating supplier,” they can turn down your request and charge you anything they want. You should also ensure that both your doctor and the supplier are enrolled in Medicare insurance. If they aren’t, that may mean they don’t meet Medicare’s strict standards to qualify or don’t want to accept Medicare insurance. As a result, Medicare insurance will not cover your DME.
With Medicare insurance coverage, you’ll likely be expected to pay 20 percent of the Medicare-approved amount, as well as your Part B deductible, for your DME. If you have a Medicare Advantage plan, it will define the out-of-pocket costs of your DME.
In some areas, the Medicare program will hold a Competitive Bidding Program, where companies make bids to supply the DME needs of Medicare-enrollees. The Medicare program will base the price of the equipment off these bids. This program is not everywhere in the United States, only in competitive bidding areas. The Medicare program thoroughly vets each company before accepting a bid.
The Different Types of DME
You’re probably wondering 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, so check with your doctor to see if what you need is considered a DME.
In some instances, you will not be able to purchase this type of equipment, only rent. This choice is usually made by the Medicare program or the insurance company, in the case of Medicare Advantage plans. Sometimes, you may have to rent the DME for a period of time, and then you can take ownership of it afterward.
Should a Medicare-covered item break or require repairs while you’re renting it, you won’t need to pay to replace it. You will be expected to pay 20 percent of the rental fee, however. If you own the equipment and it is covered by Medicare insurance, the Medicare program will cover 80 percent of any approved repairs or maintenance while you cover the rest.
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DME is essential for many seniors on Medicare insurance. 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 — Durable medical equipment (DME) coverage