Medicare Coverage of Durable Medical Equipment

Medicare Durable Medical Equipement

Physical limitations greatly impact quality of life. If you struggle to get around, breathe, or perform day-to-day tasks without physical support, durable medical equipment can help. Medicare helps cover durable medical equipment, and a Medicare supplement plan can pay the gaps.

What Is Durable Medical Equipment (DME)?

 Durable medical equipment, or DME, is any medical device used at home to aid daily life. To be DME, equipment must be doctor prescribed and:

  • Durable
  • Used in your home
  • Expected to last three years
  • Used for a medical reason
  • Not useful to someone who isn’t sick or injured

Wheelchairs, nebulizers, and walkers are common forms of DME. Products like these are essential for common daily tasks.

Disposable items such as bandages, needles, and gloves are not considered to be DME. While you may need to use them daily, they cannot be prescribed by a doctor and do not have an expected lifetime of at least three years.

How Can I Get Durable Medical Equipment?

To find places that sell DME in your area, you can use this tool. When you enter your zip code and answer the additional questions, it will generate a list of stores and pharmacies that offer the DME you need. You can also ask your doctor or health care provider where you can pick up your DME.

It is important to note that you can only get DME from a supplier enrolled in Medicare. This ensures coverage for your equipment.

Does Medicare Cover My Durable Medical Equipment?

In short, yes, Medicare covers durable medical equipment. You must have Medicare Part B for Medicare to cover your DME. Additionally, you will need a doctor to deem your DME medically necessary. And you must have a prescription.

If you live in a nursing home or facility, this does not qualify as a “home” under Medicare. This is true even if it is a Medicare-covered facility. Because of this, you will not be able to receive covered benefits in these places. However, a long-term care facility does qualify as a “home,” and you can receive covered benefits there. If you are in a skilled nursing facility, they might provide you with DME. If so, they are responsible for the equipment.

What Is the Cost of Durable Medical Equipment?

For walkers, CPAP machines, crutches, wheelchairs, and other standard DME, you will pay 20% of the Medicare-approved amount. First, you must pay and meet your Medicare Part B deductible for the year. Your payments will vary depending on if you rent or buy the equipment.

If you need prosthetic items such as ostomy bags, artificial limbs and eyes, orthopedic shoes, cochlear implants, and more, you will only pay 20% of the Medicare-approved amount if your supplier accepts assignment. This means they accept the Medicare-approved amount as full payment. If a supplier does not accept assignment, these costs might be different.

For corrective lenses, Medicare covers one pair of contact lenses or glasses after surgery. After you pay your annual Part B deductible, you will pay 20% of the Medicare-approved amount. These costs may be different if your doctor does not accept assignment.

How We Can Help

Copayments and coinsurance can become expensive depending on the amount of DME you need. Contingent on which plan you choose, a Medicare supplement plan can cover the 20% gap that Medicare does not pay. This could mean that all of your costs could potentially be covered for DME. For more information on how a Medicare supplement plan can help you pay for your DME, contact us at (800) 310-2550 or get a free quote here.

Compare Your Medicare Supplement Rates Immediately!

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