As you age, certain medical equipment may be necessary. If you use durable medical equipment (DME) and/or medical supplies which assist you in your daily functions, those items may be covered by Medicare Part B. Be aware that Medicare covers the basic model of that equipment. If you want to add on expensive upgrades, you typically will have to pay for any extra charges. What Medical Equipment is Covered by Medicare?
What Durable Medical Equipment (DME) is Covered by Medicare?
Some DME items must be purchased and other items can be rented. Generally, after 13 months of renting equipment, you will be able to own it. However, although oxygen equipment is always rented, you cannot purchase it. See below for a list of DME equipment and supplies that are covered when medically necessary:
- Air-fluidized beds and other support surfaces (for rental use only)
- Blood sugar monitors
- Blood sugar (glucose) test strips
- Canes (except white canes for the blind)
- Commode chairs
- Continuous passive motion (CPM) machine
- Crutches
- Hospital beds
- Incontinence products
- Infusion pumps and supplies (if necessary to administer certain drugs)
- Manual wheelchairs and power mobility devices
- Nebulizers and nebulizer medications
- Oxygen equipment and accessories
- Patient lifts
- Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
- Suction pumps
- Traction equipment
- Walkers
What Durable Medical Equipment (DME) is NOT Covered by Medicare?
- Medicare will not pay for durable medical equipment which is used outside of the home. If you do not need it for assistance at home, then it will not be covered. An example would be a motorized scooter for use outside the home only, given that you can get around your house without it
- Items only intended for ease or comfort, i.e. stairway elevators, grab bars, air conditioners, bathtubs and toilet seats
- Any modifications made to your home, i.e. ramps, widened doors, to facilitate wheelchair access
- Equipment not suitable for home use, i.e. paraffin bath units and oscillating beds
- Disposable items or items not used with equipment, incontinence pads, catheters, surgical face masks, or compression leggings. Note: If you get home health care, Medicare will pay for some of these items as part of your benefit, such as intravenous supplies, gauze, and catheters.
There are criteria that the DME must meet prior to being approved by Medicare, as follows:
- It must be “durable”, resilient and long-lasting
- It must be medically necessary and prescribed by your physician or other health care provider to be used at home. Note: It cannot be more than 6 months before the date of the order
- It must not be used by someone else who isn’t sick or injured
- It must be strong enough to withstand repeated use and last for at least 3 years.
Special Requirements for Certain DME Items
There are special rules for items that are more expensive, some examples are below:
Wheelchairs: Your healthcare provider’s order should indicate the following:
- that it is difficult for you to manage at home with just a cane or a walker. You must also be having difficulties in your daily functioning as getting dressed or bathing.
- the date of your office visit
- that you can use the wheelchair safely.
Power scooters:
- The scooter must be ordered within 45 days of your healthcare provider’s prescription. His order will have to stipulate that you have the same problems listed above for getting a wheelchair. However, the order must also stipulate that you can’t use a manual wheelchair but could safely use a powered one.
Please note that some states have additional rules and required forms for wheelchairs and scooters. Check with your doctor to be sure you follow those rules.
How Do You Get Durable Medical Equipment (DME) Covered by Medicare?
You must get your DME from a Medicare-approved supplier. Both Original Medicare and Medicare Advantage plans have approved lists of suppliers. To find them in your area, go to the supplier directory at www.medicare.gov/supplierdirectory/search.html. You will need to use suppliers that are “approved” by your plan – either original Medicare or Medicare Advantage.
Medigap plans will also cover DME if Medicare approves it. It will be covered as a normal Part B charge – the Medicare Part B deductible will apply if you have a Medigap plan that does not cover the deductible. But after that Medicare and the Medigap plan should cover your costs in full for covered equipment.
DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
Competitive Bidding Program:
After suppliers submit their bids to provide certain DME and supplies in competitive bidding areas, an amount is agreed upon by Medicare for payment of each item. Medicare contract suppliers are selected from the suppliers with winning bids.
- This program is cost-effective. Its primary goal is to save Medicare and its beneficiaries money.
- It operates in certain zip codes in the Northeast, South, Midwest and West.
- It ensures that you get top quality products from Medicare-approved suppliers.
- It helps to minimize fraudulent and abusive practices in the Medicare system.
If you have questions about what Medicare will or will not cover, it is best to contact Medicare directly before agreeing to pursue purchasing or renting any equipment. You can find some information on Medicare’s website or by calling them at 1-800-MEDICARE.
Senior.com does not accept Medicare. However, our customers regularly get prior approval from Medicare for DME products and then submit the receipt with proper paperwork for reimbursement to Medicare.
What Medical Equipment is Covered by Medicare?
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