Durable medical equipment, often abbreviated as DME, refers to quite a lot of medical devices, supplies and equipment that will help individuals with chronic health conditions or disabilities. Examples include wheelchairs, walkers, hospital beds, diabetic supplies, home oxygen equipment and rather more.
Fortunately, DME is usually covered by Original Medicare, although these devices and supplies must meet specific criteria. To be covered by Medicare, durable medical equipment have to be medically obligatory, able to face up to repeated, long-term use (a minimum expectancy of three years) inside a house.
So, what exactly does Medicare cover? And the way do you get the supplies you wish? Let’s have a look.
Medicare coverage of DME
Medicare Part B, also referred to as medical insurance, will cover durable medical equipment that’s considered medically obligatory. Specific DME supplies and devices have to be doctor prescribed, and your doctor have to be a Medicare-enrolled provider. In case your doctor isn’t Medicare-approved and has not accepted you as a Medicare patient, you might find yourself paying out of pocket. Be sure that to verify this stuff prematurely so that you don’t find yourself with a surprise bill. You’ll be able to double check in case your doctor is Medicare-approved online or you’ll be able to call your provider’s office directly.
Also, your DME have to be administered by a DME supplier who has been approved by Medicare. The equipment you employ could also be rented or purchased directly – it is dependent upon your device’s reusability, frequency of use and what Medicare requires for specific DME. With dearer varieties of DME (like wheelchairs and scooters), most individuals select to start out off renting.
But what are you able to expect by way of cost? When you meet your deductible, which is the quantity you have to pay before Medicare starts covering claims, you’ll begin paying 20% of the overall amount for DME supplies – that is referred to as a coinsurance. In the event you’re renting equipment, you’ll more than likely pay 20% of your monthly cost to rent. Depending on what form of equipment you wish, coverage stipulations may vary.
For many who have a Medicare Advantage plan (also referred to as Part C), access to DME often works the identical way. In actual fact, all Part C plans are legally required to cover the identical medically obligatory equipment and supplies as Original Medicare. Nonetheless, based on what form of plan you might have, costs could be very different. And lots of Medicare Advantage plans offer additional advantages to make sure you get the care you wish.
Here’s a listing of durable equipment commonly covered by Medicare
What DME medical supplies are you able to expect to be covered? It is dependent upon plenty of aspects, but listed here are some examples of the equipment which might be most asked about.
Adjustable beds and Medicare coverage
Medicare will cover some adjustable beds as DME. A bed is taken into account adjustable if it will probably be lowered or raised to assist a patient find essentially the most comfortable or medically useful position.
Medicare only considers an adjustable bed DME if it will probably elevate or lower from the pinnacle or foot and has side or safety rails that will also be adjusted. But is that the identical thing as a hospital bed? And if not, does Medicare cover hospital beds? While not all hospital beds are adjustable, adjustable beds themselves are considered a sort of hospital bed. And should you’re eligible for an adjustable bed, you’re more than likely also eligible for a mattress covered by Medicare. Nonetheless, this doesn’t apply to plain mattresses. They have to be a particular sort of hospital bed mattress or pressure-reducing mattress that has been deemed medically obligatory.
Bath lifts and Medicare coverage
Sometimes getting in and out of the tub could be difficult. That’s where bath lifts are available in. Users can get themselves situated on a seat that lowers them into the water and helps them get back out. Unfortunately, Medicare doesn’t consider bath lifts a sort of DME. They’re classified as more of a convenience item than a medical necessity.
Lift chairs and Medicare coverage
A lift chair is a sort of motorized lift that safely assists a user in and out of a seated position by physically lifting their recliner or chair. They’re incredibly helpful for those with physical disabilities and mobility issues. Lift chairs and lift recliners are covered by Medicare Part B. They’re considered DME because they could be used to assist treat certain medical conditions, like arthritis, hip and joint pain and muscle issues. Just make certain that your selection is a Medicare-approved lift chair that’s prescribed by your doctor.
Stair lifts and Medicare coverage
Although very helpful, stair lifts usually are not considered durable medical equipment – why? Most stair lifts include a security seat that’s attached on to a motor-powered track. These tracks are typically built directly into or on a set of stairs, which makes this equipment more of a house improvement update. And since Medicare covers DME provided that medically obligatory, home modifications usually are not classified as essential.
Wheelchairs, walkers and Medicare coverage
Most wheelchairs, power-operated vehicles like scooters, walkers and rollators are covered by Medicare. Nonetheless, very like different kinds of durable medical equipment, your device have to be prescribed by your doctor for home use and purchased or rented through a Medicare supplier.