Certain medical conditions require the use of medical equipment to help address mobility issues, administer medication, or provide relief from symptoms of an illness or injury. Medicare benefits may be available to help reduce out-of-pocket expenses for medically necessary medical supplies when recipients qualify for durable medical equipment (DME) coverage.
Common Types of Durable Medical Equipment
Generally, equipment meets the definition of DME for Medicare when it is reusable, designed for clinical use in the home and expected to withstand use for at least 3 years. These items must be determined as medically necessary and require a health care professional’s referral or prescription.
Durable medical equipment may include:
- Monitors and test strips for blood sugar.
- Wheelchairs, walkers, scooters, crutches and canes.
- Continuous passive motion devices.
- Commode (toilet) chairs.
- Continuous positive airway pressure (CPAP) devices.
- Hospital or pressure-reducing beds, mattresses and mattress covers.
- Traction equipment and patient lifts.
- Oxygen machines and associated accessories.
- Nebulizers and their medication.
- Infusion pumps and associated supplies.
- Portable suction pumps.
- Lancets and lancet devices.
Who Determines Need for Durable Medical Equipment?
For many patients, their primary care physician evaluates and determines the need for DME. However, specialists such as occupational or physical therapists may also play an important role in establishing orders for a certain type of DME. Licensed nurse practitioners may also provide orders for equipment.
Although they may not be qualified to order equipment directly, social workers and certain agency representatives may also help patients secure the appropriate order for DME if their primary care physician is unavailable.
Medicare Coverage for Durable Medical Equipment
When you’re navigating the costs associated with DME, your Medicare Part B terms apply. This means that in order for Medicare Part B to help mitigate the costs of your DME, you must be up-to-date on your monthly premium. The Part B deductible also applies and recipients are expected to pay 20% of what Medicare benefits establish as the cost of the DME being ordered.
Prescribing health care professionals and equipment suppliers must also be Medicare-approved and equipment suppliers must be participating with Medicare assignment for DME. If your health care professional who orders the DME or the equipment supplier are not enrolled with Medicare, you may be responsible for the full cost associated with the DME you need.
Equipment provided to you in a skilled nursing facility or rehabilitation center is not included in Part B DME coverage. Your Part A coverage applies to this situation and the facilities must include the use of that equipment in their services for the first 100 days of your stay. Long-term care facilities will bill DME under Part B, however.
Medigap or Medicare Supplement plans can help offset the cost of certain expenses, such as deductibles or coinsurance amounts. Some Medicare Advantage plans may offer similar benefits. While Medigap plans are standardized across most states and carriers, Medicare Advantage plans differ between locations and insurers.