What is Medicare Coverage for Durable Medical Equipment (DME)?
What is Medicare Coverage for Durable Medical Equipment (DME)? Whether you use a walker, a blood pressure monitor, crutches or other items that are used to improve your health, there’s no doubt that having access to medical equipment can improve your quality of life and maybe even save it.
Medicare Benefits Solutions
Oct 4, 2021
Medicare benefits may cover medical equipment purchases and rentals, depending on your circumstances and the type of equipment you need. If you are eligible for Medicare and are wondering how it will help pay for medical equipment or supplies, you’re not alone. Millions of Americans rely on Medicare to help pay for durable medical equipment.
How does Medicare cover durable medical equipment (DME)?
Original Medicare uses the term “durable medical equipment” or “DME” to refer to medical equipment items it covers. Durable medical equipment as it pertains to Medicare includes items that are intended for repeated use. Per this definition, single-use items are usually disqualified from DME coverage. There are exceptions, however, for items like glucose test strips that are used alongside monitoring equipment supplied by Medicare-approved distributors. Even though these items are usually single-use, they are classified under DME coverage where Medicare is concerned.
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What Part of Medicare Covers Durable Medical Equipment?
Medicare benefits are supplied via different parts of the program. Medicare Part B is the outpatient benefit and covers not only things like doctor visits and surgery, but it also covers DME. For most Medicare recipients, DME is covered at the standard Part B rate of 80%. This leaves the remaining 20% to be covered by the Medicare recipient.
While Part B covers DME for use at home, you may be provided DME while in a hospital setting. In these types of situations, Medicare will still provide coverage; however, DME coverage in a hospital setting will likely take place under Medicare Part A, the inpatient benefit.
As long as the DME in a hospital setting is provided by the facility and is only used at the facility, Part A supplies coverage. If DME is provided in the hospital or in a skilled nursing facility and is then taken with you for use at home, coverage consideration would shift back to Part B.
Rentals vs. Purchases
In some cases, a piece of DME will need to be rented prior to a full purchase being covered. Medicare Part B usually covers rentals of DME that are eligible for purchase, but timeframe requirements for rentals before purchase may vary. Renting DME is often the best course of action when the equipment will only need to be used for a short period of time. If you suffer from a chronic condition, purchasing the equipment will often make more sense in the long run.
Non-Prescription Durable Medical Equipment
It’s important to note that Medicare’s coverage of DME only extends to items which have been ordered by a Medicare-participating physician. This means that you will not be able to receive coverage for items that you purchase on your own, including equipment for sale at retail health stores and pharmacies. Any DME will also need to come from a Medicare-approved provider. This is to reduce the potential for fraud on the part of medical equipment suppliers, but it is also to ensure that Medicare recipients are billed correctly for the items that have received coverage.
Medicare Advantage Coverage for DME
Medicare Advantage plans must include the same Part A and Part B benefits as Original Medicare, but many plans offer additional coverage. Check with your plan directly for questions regarding your DME. You may need to get your equipment from a supplier within your plan’s network.