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What is durable medical equipment (DME) and will Medicare cover it?

Durable medical equipment, often abbreviated as DME, refers to a variety of medical devices, supplies and equipment that can help people with chronic health conditions or disabilities. Examples include wheelchairs, walkers, hospital beds, diabetic supplies, home oxygen equipment and much more.

Fortunately, DME is typically covered by Original Medicare, although these devices and supplies must meet specific criteria. To be covered by Medicare, durable medical equipment must be medically necessary, able to withstand repeated, long-term use (a minimum expectancy of three years) within a home.

So, what exactly does Medicare cover? And how do you get the supplies you need? Let’s take a look.

Medicare coverage of DME

Medicare Part B, also known as medical insurance, will cover durable medical equipment that’s considered medically necessary. Specific DME supplies and devices must be doctor prescribed, and your doctor must be a Medicare-enrolled provider. If your doctor isn’t Medicare-approved and has not accepted you as a Medicare patient, you may end up paying out of pocket. Make sure to confirm these things in advance so you don’t end up with a surprise bill. You can double check if your doctor is Medicare-approved online or you can call your provider’s office directly.

Also, your DME must be administered by a DME supplier who has been approved by Medicare. The equipment you use may be rented or purchased directly – it depends on your device’s reusability, frequency of use and what Medicare requires for specific DME. With more expensive types of DME (like wheelchairs and scooters), most people choose to start off renting.

But what can you expect in terms of cost? Once you meet your deductible, which is the amount you need to pay before Medicare starts covering claims, you will begin paying 20% of the total amount for DME supplies – this is known as a coinsurance. If you’re renting equipment, you’ll most likely pay 20% of your monthly cost to rent. Depending on what kind of equipment you need, coverage stipulations may vary.

For those who have a Medicare Advantage plan (also known as Part C), access to DME often works the same way. In fact, all Part C plans are legally required to cover the same medically necessary equipment and supplies as Original Medicare. However, based on what kind of plan you have, costs can be very different. And many Medicare Advantage plans offer additional benefits to ensure you get the care you need.

Here’s a list of durable equipment commonly covered by Medicare

What DME medical supplies can you expect to be covered? It depends on a lot of factors, but here are some examples of the equipment that are most asked about.

Adjustable beds and Medicare coverage

Medicare will cover some adjustable beds as DME. A bed is considered adjustable if it can be lowered or raised to help a patient find the most comfortable or medically beneficial position.

Medicare only considers an adjustable bed DME if it can elevate or lower from the head or foot and has side or safety rails that can also be adjusted. But is that the same thing as a hospital bed? And if not, does Medicare cover hospital beds? While not all hospital beds are adjustable, adjustable beds themselves are considered a type of hospital bed. And if you’re eligible for an adjustable bed, you are most likely also eligible for a mattress covered by Medicare. However, this does not apply to standard mattresses. They must be a specific type of hospital bed mattress or pressure-reducing mattress that has been deemed medically necessary.

Bath lifts and Medicare coverage

Sometimes getting in and out of the bath can be difficult. That’s where bath lifts come in. Users can get themselves situated on a seat that lowers them into the water and helps them get back out. Unfortunately, Medicare doesn’t consider bath lifts a type of DME. They’re classified as more of a convenience item than a medical necessity.

Lift chairs and Medicare coverage

A lift chair is a type of motorized lift that safely assists a user in and out of a seated position by physically lifting their recliner or chair. They’re incredibly helpful for those with physical disabilities and mobility issues. Lift chairs and lift recliners are covered by Medicare Part B. They’re considered DME because they can be used to help treat certain medical conditions, like arthritis, hip and joint pain and muscle issues. Just make sure that your selection is a Medicare-approved lift chair that is prescribed by your doctor.

Stair lifts and Medicare coverage

Although very helpful, stair lifts are not considered durable medical equipment – why? Most stair lifts include a safety seat that’s attached directly to a motor-powered track. These tracks are typically built directly into or on a set of stairs, which makes this equipment more of a home improvement update. And because Medicare covers DME only if medically necessary, home modifications are not classified as essential.

Wheelchairs, walkers and Medicare coverage

Most wheelchairs, power-operated vehicles like scooters, walkers and rollators are covered by Medicare. However, much like other kinds of durable medical equipment, your device must be prescribed by your doctor for home use and purchased or rented through a Medicare supplier.

https://www.healthpartners.com/blog/what-is-durable-medical-equipment-dme/

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