Medicare Coverage For Durable Medical Equipment (DME)

Medicare Coverage For Durable Medical Equipment (DME)

Durable Medical Equipment (DME) coverage:

• How often is it covered?
• Medicare Part B (Medical Insurance) covers medically necessary durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:
• Durable (can withstand repeated use)
• Used for a medical reason
• Not usually useful to someone who isn’t sick or injured
• Used in your home

Has an expected lifetime of at least 3 years

DME that Medicare covers includes, but isn’t limited to:

• Air-fluidized beds and other support surfaces (these supplies are only rented)
• Blood sugar monitors
• Blood sugar (glucose) test strips
• Canes (however, white canes for the blind aren’t covered)
• Commode chairs
• Continuous passive motion (CPM) machine
• Crutches
• Hospital beds
• Infusion pumps and supplies (when necessary to administer certain drugs)
• Manual wheelchairs and power mobility devices
• Nebulizers and nebulizer medications
• Oxygen equipment and accessories
• Patient lifts
• Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
• Suction pumps
• Traction equipment
• Walkers

Who’s Eligible & Costs?

• Who’s eligible?
• All people with Part B are covered.
• Your costs in Original Medicare
• If your supplier accepts assignment, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:
• You may need to rent the equipment.
• You may need to buy the equipment.
• You may be able to choose whether to rent or buy the equipment.
• Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.
• t’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept an assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept an assignment. If suppliers don’t accept assignment, there’s no limit on the amount they can charge you.
• Competitive Bidding Program
• If you live in or visit certain areas, you may be affected by Medicare’s Competitive Bidding Program. In most cases, Medicare will only help pay for the equipment and supplies if they’re provided by contract suppliers when both of these apply:
• You have Original Medicare.
• You get competitively bid equipment and supplies in competitive bidding areas.

Contract suppliers can’t charge you more than the 20% coinsurance and any unmet yearly deductible for any equipment or supplies included in the Competitive Bidding.

 

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