What is Durable Medical Equipment?
Hospitals, healthcare facilities, and home healthcare workers use a wide variety of Durable Medical Equipment (DME) and supplies to care for their patients and keep them safe and comfortable. This list of items includes, but is not limited to: monitoring systems, glucose meters, thermometers, syringes, specialty bags, wound care supplies, wheelchairs (electric, lightweight, or standard), portable commodes, walkers, mobility ramps, bath benches, catheters, adult diapers, and latex gloves.
Medicare does not cover all of the items listed; however, they may cover the cost of certain Durable Medical Equipment and supplies that meet their requirements. Learn more about what types of DME are covered, what you will expect to pay, and where to find Medicare-approved providers.
What does Durable Medical Equipment Coverage Pay?
Medicare Part A covers some of the Durable Medical Equipment costs for individuals who need it in a skilled nursing facility or hospital. If the equipment is medically necessary and purchased from an approved supplier, Medicare Part A will pay 80% of the approved DME after you’ve met the annual deductible. The patient or their supplemental insurance will be responsible for paying the remaining 20% and any amount over the allowable limit.
Medicare Part B covers Durable Medical Equipment and supplies used to treat patients in their own homes, even if they are not confined there. In addition to a private home, a personal care residence, such as an assisted living facility, can be considered a “home.” Home medical equipment must be medically necessary, prescribed by a Medicare-enrolled physician, and purchased from a Medicare-approved supplier. Medicare Part B pays for 80% after you’ve met the annual deductible. The patient or their supplemental insurance is responsible for the remaining 20% and any amount over the allowable limit.
Medicare Part C, also known as Medicare Advantage, is required to provide the same coverage as Part A and Part B. If you have Part C, your plan will pay at least 80% of the allowable limit for qualified Durable Medical Equipment.
What Type of Durable Medical Equipment Does Medicare Cover?
Think of Medicare’s Durable Medical Equipment coverage as having two tiers. DME is covered when determined to be medically necessary, and some DME is not covered despite being medically necessary. For example, grab bars in a shower may be recommended by a physical therapist as required. Still, Medicare does not consider them to be medical equipment and will not cover their cost. Generally, if an item can withstand repeated use, is primarily designed for medical use, and is appropriate for use in the home, it will most likely be covered. DME items that Medicare covers:
- Air fluidized beds
- Blood Lancets
- Blood sugar test strips
- Blood sugar monitors
- Commode chairs
- CPAP devices
- Diabetic test strips
- Home oxygen equipment
- Hospital beds
- Infusion pumps
- Nebulizers Patient lifts
- Powered wheelchairs
- Suction pumps
- Traction equipment
For seniors to remain independent, they need to have mobility. Medicare Part B covers power-operated vehicles (scooters) and manual wheelchairs as one of the most requested pieces of Durable Medical Equipment (DME) that your doctor can prescribe. To qualify for a wheelchair, you must have a face-to-face examination and a written prescription from a Medicare-approved doctor or healthcare provider. With that prescription, Part B will cover power wheelchairs deemed medically necessary.
Medicare DME Costs
If your Durable Medical Equipment supplier accepts assignment, you pay 20% of the Medicare-approved amount once you reach the Part B deductible. Medicare pays for different kinds of DME in different ways, depending on the type of equipment. You may be required to rent or buy the equipment based on their policy. Some plans give you the flexibility to choose whether you want to rent or buy.
For Medicare to pay the cost of your DME, your prescribing doctor and suppliers must enroll in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in the Medicare program. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.
What Type of Durable Medical Equipment Does Medicare Not Cover?
In most cases, Medicare does not cover medical supplies, like catheters and syringes used once and thrown away. However, Medicare does make exceptions for specific medical supplies for treating or managing qualifying medical conditions, like lancets and test strips for diabetics. Some diabetes supplies are also covered under Medicare Part D prescription coverage. And in some instances when you qualify for home health care, Medicare may cover certain disposable items, such as intravenous supplies, gauze, or catheters.
Durable Medical Equipment Providers
Approved Medicare Suppliers have agreed to accept the Medicare-approved price for a specific item of DME. Purchasing from a participating Medicare Supplier ensures the individual will not pay more than a 20% co-pay for the Medicare-approved price for an item.
Medicare Suppliers enrolled in Medicare’s program and will accept Medicare as a form of payment, still have the flexibility to set their own prices, By purchasing from a Medicare-approved DME Supplier, the individual may or may not spend the least amount out-of-pocket.
There are also DME Suppliers that Medicare does not approve. If one purchases from these suppliers, Medicare will not pay any portion of the cost. So before purchasing DME, it is important to know that purchasing Durable Medical Equipment from a Medicare-approved supplier does not guarantee the lowest price. You can find Medicare suppliers and compare prices using Medicare’s searchable database to search by item type and zip code.
Renting vs Buying With Medicare
Are you thinking about buying or leasing your DMEs? Typically, the decision is made by Medicare and in most cases, they will choose to rent. In most cases, Medicare will only buy inexpensive DME or equipment that needs to be custom-made for an individual. Renting often works in the patient’s favor since they won’t be charged for replacement or repairs if the item is defective. The Medicare-approved supplier will inform you if the item they need is available for rent or purchase.
No one can predict what the future holds for them health-wise, so it’s best to be prepared by staying active, maintaining your health, and keeping informed of the Medicare options that best suit your needs.
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