What Durable Medical Equipment Does Medicare Cover?

As we age, our healthcare needs change and we often require specialized medical equipment to manage our conditions. One of the biggest concerns for many seniors is the cost of these devices, but thankfully, Medicare can help cover some of the expenses.

But what durable medical equipment (DME) does Medicare actually cover? In this article, we’ll explore the different types of DME that Medicare can help pay for and what you need to know to get the equipment you need.

What Durable Medical Equipment Does Medicare Cover?

Durable Medical Equipment (DME) is a broad term that refers to medical equipment that is designed for long-term use. Medicare is a federal health insurance program that covers the costs of certain types of DME for eligible beneficiaries. In this article, we will explore what types of DME Medicare covers and how to get them.

1. Mobility Aids

Mobility aids are devices that help individuals with mobility impairments move around more easily. Medicare covers a variety of mobility aids, including:

Canes and Crutches

Medicare covers canes and crutches that are medically necessary. This includes standard canes, quad canes, and forearm crutches.

Walkers

Medicare covers walkers that are medically necessary. This includes standard walkers, rolling walkers, and knee walkers.

Wheelchairs and Scooters

Medicare covers manual and power wheelchairs, as well as scooters, for individuals who have a mobility impairment that makes it difficult to move around the home or community.

2. Home Oxygen Equipment

Home oxygen equipment is used to treat respiratory conditions that prevent individuals from getting enough oxygen. Medicare covers home oxygen equipment, including:

Oxygen Concentrators

Medicare covers oxygen concentrators that are prescribed by a doctor for use in the home.

Portable Oxygen Equipment

Medicare covers portable oxygen equipment, such as tanks or portable concentrators, for use outside the home.

3. Hospital Beds and Accessories

Hospital beds are designed to provide individuals with a comfortable and safe place to sleep or rest while they recover from an illness or injury. Medicare covers hospital beds and accessories that are medically necessary.

Electric Hospital Beds

Medicare covers electric hospital beds that are prescribed by a doctor for use in the home.

Bedside Rails

Medicare covers bedside rails that are medically necessary.

4. Prosthetic Devices

Prosthetic devices are artificial limbs or body parts that are designed to replace missing or damaged body parts. Medicare covers prosthetic devices, including:

Limb Prostheses

Medicare covers prosthetic limbs that are medically necessary.

Breast Prostheses

Medicare covers external breast prostheses that are prescribed after a mastectomy.

5. Enteral and Parenteral Nutrition

Enteral and parenteral nutrition are used to provide individuals with the nutrients they need when they are unable to eat or digest food normally. Medicare covers:

Enteral Nutrition

Medicare covers enteral nutrition supplies and equipment, including feeding pumps, feeding tubes, and formula.

Parenteral Nutrition

Medicare covers parenteral nutrition supplies and equipment, including pumps and nutrients.

6. Continuous Positive Airway Pressure (CPAP) Devices

CPAP devices are used to treat sleep apnea, a condition that causes individuals to stop breathing during sleep. Medicare covers CPAP devices that are prescribed by a doctor.

7. Blood Glucose Monitors and Supplies

Blood glucose monitors and supplies are used to monitor blood sugar levels in individuals with diabetes. Medicare covers:

Blood Glucose Monitors

Medicare covers blood glucose monitors that are prescribed by a doctor.

Blood Glucose Test Strips

Medicare covers blood glucose test strips that are prescribed by a doctor.

8. Therapeutic Shoes or Inserts

Therapeutic shoes or inserts are designed to help individuals with diabetes prevent foot injuries. Medicare covers one pair of therapeutic shoes or inserts per year for eligible beneficiaries.

9. Seat Lift Mechanisms

Seat lift mechanisms are devices that help individuals with mobility impairments stand up from a seated position. Medicare covers seat lift mechanisms that are medically necessary.

10. Traction Equipment

Traction equipment is used to treat spinal conditions that cause pain or discomfort. Medicare covers traction equipment that is prescribed by a doctor.

In conclusion, Medicare covers a variety of DME for eligible beneficiaries. To get DME covered by Medicare, you must have a doctor’s prescription and meet certain eligibility requirements. If you have any questions about what DME Medicare covers or how to get it, talk to your doctor or contact Medicare directly.

Frequently Asked Questions

What is Durable Medical Equipment (DME)?

Durable Medical Equipment (DME) is equipment that is primarily and customarily used to serve a medical purpose, can withstand repeated use, and is appropriate for use in the home. DME includes items like walkers, wheelchairs, and oxygen equipment that are prescribed by a doctor for a medical reason.

Examples of DME include hospital beds, oxygen equipment, commode chairs, crutches, and walkers. Some items, such as blood sugar monitors and blood pressure monitors, may only be covered as DME under certain circumstances.

What DME does Medicare cover?

Medicare Part B covers a wide range of DME that is medically necessary for the treatment of a medical condition or illness. This includes items such as wheelchairs, walkers, hospital beds, oxygen equipment, and more.

However, not all DME is covered by Medicare. Items that are primarily used for comfort or convenience, such as air conditioners or stair lifts, are not covered. Additionally, Medicare may only cover certain types of DME under certain circumstances.

How do I get DME covered by Medicare?

To get DME covered by Medicare, you must first have a prescription from your doctor. The prescription must include the medical need for the equipment and the length of time it will be needed. Once you have the prescription, you can contact a Medicare-approved supplier to order the equipment.

The supplier will work with Medicare to determine if the equipment is covered and what your out-of-pocket costs will be. You may be required to pay a portion of the cost, known as a co-payment or co-insurance.

What if I need DME that is not covered by Medicare?

If you need DME that is not covered by Medicare, you may be able to purchase the equipment on your own or through a private insurance plan. You can also appeal a decision by Medicare if you believe that the equipment is medically necessary and should be covered.

It is important to note that if you choose to purchase DME on your own, you may not be able to get reimbursed by Medicare or your insurance plan.

Can I rent DME instead of buying it?

Yes, Medicare Part B covers the rental of certain types of DME, including hospital beds, oxygen equipment, and wheelchairs. The rental period is typically up to 13 months, after which you may have the option to purchase the equipment.

If you need the equipment for a longer period of time, you can contact the supplier to extend the rental agreement. However, you will still be required to pay any applicable co-payments or co-insurance.

Medicare Durable Medical Equipment

In conclusion, Medicare is an excellent resource for seniors who need durable medical equipment. Understanding what they cover can help you make informed decisions about your healthcare needs. Keep in mind that many items require prior authorization, so it’s essential to work closely with your healthcare provider to ensure you receive the equipment you need. With Medicare’s coverage, you can rest assured that you’ll have access to the necessary equipment to help you maintain your independence and quality of life.

It’s important to note that Medicare’s coverage for durable medical equipment is continuously changing. To stay up-to-date on the latest information, it’s essential to regularly check the Medicare website and speak with your healthcare provider. By taking advantage of Medicare’s benefits, you can ensure that you receive the care and equipment you need to live a healthy, active life.

In summary, Medicare covers a wide range of durable medical equipment, including wheelchairs, oxygen equipment, and prosthetic devices. However, coverage varies depending on the item and the individual’s specific needs. By working closely with your healthcare provider, you can determine what equipment you need and ensure that you receive the coverage you’re entitled to. With Medicare’s help, you can enjoy greater independence, mobility, and overall well-being.