Medicare Coverage of Durable Medical Equipment (DME) and Other Devices

Understanding what Durable Medical Equipment (DME) Medicare covers and how you can access it is essential for many beneficiaries. DME includes items you may need to manage health conditions at home, ranging from wheelchairs to oxygen equipment. This blog post covers key details about what Medicare Part B covers, the costs involved, and how to ensure you receive the equipment you need.

What is Durable Medical Equipment (DME)?

Durable Medical Equipment (DME) refers to reusable medical equipment that is medically necessary and prescribed by a doctor. This includes a wide range of items designed to assist individuals with medical conditions in their daily lives. Some common examples of DME include:

• Home oxygen equipment

• Wheelchairs (manual or powered)

• Hospital beds

• Walkers

In addition to these items, Medicare also covers specific prosthetic devices and orthotics. For example, prosthetics like ostomy supplies, urinary catheters, and even certain eyeglasses and contact lenses fall under Medicare’s coverage. Orthotics like braces for the legs, arms, or back are also covered, as well as artificial limbs such as prosthetic legs and arms.

To receive DME coverage, a person must be enrolled in Medicare Part B, and the equipment must be deemed medically necessary by a doctor or healthcare provider.

Which of the following parts of Medicare covers durable medical equipment (dme)?

Medicare Part B covers many types of DME, prosthetics, and orthotics when deemed medically necessary. Some common DME items that Medicare covers include:

• Canes

• Commode chairs

• Crutches

• Continuous Positive Airway Pressure (CPAP) machines

• Glucose monitors and supplies

• Infusion pumps

• Nebulizers and associated medications

• Patient lifts

• Pressure-reducing mattresses

In general, Medicare Part B covers 80% of the Medicare-approved amount for most DME, leaving the beneficiary responsible for 20% of the costs, after they meet the Part B deductible. The exact amount you pay may vary depending on the item and whether you purchase or rent it.

Purchasing vs. Renting Durable Medical Equipment

A common question Medicare beneficiaries face is whether they can purchase or must rent the DME they need. Medicare covers most DME on a rental basis, but certain items can be purchased. Typically, inexpensive or routinely bought items, such as canes, walkers, or blood sugar monitors, can be bought outright. However, more complex or expensive equipment, such as wheelchairs or hospital beds, is often rented first.

For more expensive equipment, Medicare usually pays for 13 months of rental. After that period, the equipment becomes the property of the beneficiary. It's essential to work with a Medicare-enrolled supplier, as Medicare will only pay for equipment provided by suppliers who are registered with the program.

Medicare Advantage Plans and DME

If you are enrolled in a Medicare Advantage Plan (Part C), your plan is required to cover the same categories of DME as Original Medicare (Parts A and B). However, the specific supplier you use, and your costs, may vary depending on the plan you are enrolled in.

If your Medicare Advantage Plan denies coverage for DME that you believe you need, you have the right to appeal the decision. This process allows an independent review of the denial, which may result in your plan covering the item.

Oxygen Equipment and Related Supplies

One of the more common pieces of DME covered by Medicare is oxygen equipment. If a beneficiary requires oxygen for medical purposes, Medicare covers the cost of the equipment on a rental basis. However, after 36 months of continuous use, the supplier must continue to provide the oxygen equipment for up to five years, but the monthly rental payments end after the first 36 months.

For oxygen equipment and related supplies, Medicare Part B covers 80% of the Medicare-approved amount, and the beneficiary is responsible for 20%, once they’ve met the annual deductible. If maintenance or servicing is required, the supplier is responsible for ensuring the equipment is kept in working order.

What Happens if Your DME Equipment Needs Repairs or Replacement?

If you own your equipment, it's essential to know how repairs or replacements are covered. Medicare covers 80% of the Medicare-approved amount for repairs or replacement parts for purchased DME. However, if you rent your equipment, the supplier is responsible for all maintenance and repairs to ensure it remains in working order.

If your equipment is lost or damaged in an emergency or disaster, Medicare may cover the cost of replacing the item or offer a loaner until it can be fixed.

Medicare Coverage for Power Wheelchairs and Scooters

To qualify for a power wheelchair or scooter under Medicare, a doctor must confirm that you need the device due to your medical condition. Medicare only covers power wheelchairs or scooters if they are necessary for use inside the home. Devices intended solely for outdoor use are not covered by Medicare.

Medicare is strict about ensuring beneficiaries meet the criteria for power wheelchairs and scooters. In the past, there have been instances of fraud where suppliers tried to provide equipment to individuals who didn’t qualify for these items. It’s important to work with a reputable, Medicare-enrolled supplier to avoid complications.

Choosing a Medicare-Approved Supplier

When you need DME, selecting the right supplier is essential to ensuring Medicare covers your equipment. You should always verify that the supplier is Medicare-enrolled and ask whether they accept assignment, which means they agree to the Medicare-approved amount as payment in full.

Here are a few questions you can ask when choosing a supplier:

• Are you a Medicare-enrolled supplier?

• Do you accept assignment?

• Will you bill Medicare directly for me?

If a supplier does not accept assignment, they can charge you more than the Medicare-approved amount, which could lead to higher out-of-pocket costs.

Medicare coverage for Durable Medical Equipment is crucial for many beneficiaries managing chronic conditions or recovering from medical procedures. Understanding what is covered and how to access the equipment you need is essential. If you have questions about your coverage, talk to your doctor or healthcare provider to ensure you receive the right equipment for your needs.

**Disclaimer: The information provided in this blog is for general informational purposes only and should not be construed as legal, financial, or medical advice. While we strive to keep the content accurate and up to date, the details of Medicare premiums, deductibles, and related programs are subject to change. We recommend consulting with a licensed professional or official Medicare resources for the most current and applicable information regarding your specific situation. Revive Insurance is not affiliated with Medicare or any government agency.