The treatment and management of many conditions and diseases requires the use of medical equipment. When these items are not intended to be thrown away after use — think a wheelchair that’s used for years versus incontinence pads that are used once and tossed — they are called durable.
“These items are used as part of a person’s medical treatment when recovering from an illness or helping manage a disease or disability day to day,” explains Dr. Bernard Steinbacher, senior medical director of Lyric, a health care technology firm based in King of Prussia, Pennsylvania.
Here, we detail the list of durable medical equipment, or DME, covered by Medicare, what your copayment typically is and everything else you need to know about getting the DME you need to treat and manage your condition and stay well.
What Medical Equipment Is Covered By Medicare?
Medicare covers a range of equipment — but it doesn’t cover everything.
“And there’s a difference between what’s covered if you’re on traditional Medicare — that’s Part A and Part B — versus if you’re on Part C, which is a Medicare Advantage plan,” adds Chris Orestis, a Maine-based senior care advocate and expert in retirement, long-term care and specialty senior living funding solutions, who serves as president of retirement consultancy Retirement Genius.
Here is a list of durable medical equipment covered by original, or traditional, Medicare. This list includes but isn’t limited to:
— Blood sugar meters and test strips
— Canes and crutches
— CPAP machines and accessories
— Hospital beds
— Infusion pumps and supplies
— Nebulizers and nebulizer medications
— Oxygen equipment and accessories
— Traction equipment
— Walkers, wheelchairs and scooters
— Commode chairs, patient lifts and other mobility aids
— Some prosthetic and orthotic items
— Certain disposables, including intravenous supplies, wound dressings and gauze as part of the home health care benefit
— Urological supplies
Medicare does not typically cover the following items:
— Equipment intended to be used outside the home, such as a motorized scooter for someone who’s able to walk around the house for short distances and needs the scooter only for getting around town
— Items intended for convenience or comfort, such as elevators and air conditioners
— Disposable items that are not used with equipment, such as incontinence pads or compression leggings
— Home modifications, such as ramps or widening doorways for wheelchair access
— DME that’s not used at home, such as paraffin bath units and oscillating beds that might be used in hospitals or skilled nursing facilities
— White canes for the blind
If you’re on a Medicare Advantage plan, the covered items list could look a little different, depending on the specifics of the plan. And the list can change from year to year, Orestis notes.
“There’s a lot of basic availability, but that’s why it’s important to keep an eye on open enrollment opportunities, because things can change,” he says.
[READ Does Medicare Cover Stair Lifts?]
Where Can I Get Medicare-Covered Medical Equipment?
To qualify for Medicare coverage, the medical equipment you’re receiving must come from “a Medicare-approved supplier,” says Scott R. Maibor, a licensed insurance advisor and managing director of Senior Benefits Boston LLC, a Medicare advisory based in Haverhill, Massachusetts.
If you have a Medicare Advantage plan, you’ll need to use an in-network provider that is contracted with your plan, Maibor notes.
Steinbacher recommends ensuring that the supplier is “enrolled in Medicare and accepts Medicare assignment,” which is an agreement between a health care provider and Medicare that states the provider will accept the Medicare-approved amount as full payment for the covered item. If a provider accepts assignment, that applies to all Medicare Part A- and Part B-covered services.
If you get durable medical equipment from a supplier that charges more than the Medicare-approved amount, “Medicare will not cover the excess,” Steinbacher adds. Therefore, it would be cheaper for you to purchase the equipment from a supplier who does accept Medicare assignment.
[See: Things You Should Know About Enrolling in Medicare]
Will I Have to Share the Cost for Medical Equipment?
While Medicare covers many types of durable medical equipment that can help you manage a chronic illness or recover from an acute ailment or surgery, you may have to contribute a copayment to get these items.
“Under Medicare Part B, you generally pay 20% of the Medicare-approved amount for the equipment after meeting the Part B deductible for the year,” Steinbacher notes.
A Medicare supplement plan, also called a Medigap plan, may pick up the 20% copayment cost.
For patients with a Medicare Advantage plan, “copayments and coinsurance may vary, so it’s important to check with your plan for specific details,” Steinbacher advises.
When securing DME from a supplier, check that it’s not an opt-out provider, which means the supplier has not signed up to bill Medicare for DME. Medicare won’t pay for services received from opt-out providers, so you’ll have to pay the entire cost if you take DME from this type of supplier.
[READ: Medicare Mistakes to Avoid.]
Do I Need Prior Authorization for Medical Equipment?
For all DME, your provider will need to write a prescription. Some items also require prior authorization, which means your provider must get approval from Medicare before you can receive the equipment.
“This is to ensure that the equipment you are provided is medically necessary, especially in the case of high-cost items,” Steinbacher explains.
A prior authorization request can take anywhere from three to 20 business days to be approved, depending on the item and the specifics of your plan.
Can I Rent Durable Medical Equipment?
In some cases, renting DME makes more sense than purchasing it outright. For example, you can rent hospital beds and wheelchairs, which may be ideal in the case of a short-term need, such as when recovering from surgery.
“In these cases, you would pay a monthly rental fee,” Steinbacher says.
If you’re renting DME, the supplier collects the equipment when you no longer need it and manages repairs or replacement parts.
Are Repairs, Maintenance and Loss of Medical Equipment Items Covered?
Medicare also covers maintenance and repairs for DME, as long as these repairs “are deemed necessary and performed by a Medicare-approved supplier,” Steinbacher says.
In some circumstances, such as theft or loss during a declared emergency, Medicare will pay for the replacement of certain DME.
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Does Medicare Cover Medical Equipment? originally appeared on usnews.com
