How Does Medicare Cover Durable Medical Equipment
Durable medical equipment can constitute an essential part of daily life. Also known as DME, it is reusable medical equipment such as walkers, wheelchairs or hospital beds. Medicare Part B, and as a result, Medicare Advantage, covers most DME. You may have to pay coinsurances though – Medicare Supplement Insurance can help pick up the cost of those. Knowing how each of these plans cover durable medical equipment will help you determine which is right for you.
What You’ll Learn:
|What Durable Medicare Equipment and Supplies are Covered by Medicare?||Jump to|
|What DME Supplies are Not Covered by Medicare?||Jump to|
|How Does Medigap Cover DME?||Jump to|
|How Does Medicare Advantage Cover DME?||Jump to|
What Durable Medicare Equipment and Supplies are Covered by Medicare?
Medicare Part B typically covers DME if it is durable, medically necessary, appropriate for home use and likely to last at least three years. Some examples of DMA covered by Medicare Part B are:
- Blood sugar meters
- Blood sugar test strips
- Commode chairs
- Continuous passive motion devices
- Continuous Positive Airway Pressure (CPAP) devices
- Hospital beds
- Home infusion services
- Infusion pumps and supplies
- Lancet devices and lancets
- Nebulizers and nebulizer medications
- Oxygen equipment and accessories
- Patient lifts
- Pressure-reducing support surfaces
- Suction pumps
- Traction equipment
- Wheelchairs and scooters
However, Medicare doesn’t cover all DME. If your doctors or suppliers are not enrolled, Medicare won’t pay their claims. For this reason, it’s crucial that you ask your DME suppliers whether they participate in Medicare before you get your medical supplies from them.
Are All My Cost Covered by Part B?
In a word: no. Once you meet the Part B deductible ($233 in 2022) you’re responsible for 20% of the Medicare-approved amount. This is called the Part B coinsurance. There are Medicare Supplement Insurance Plans available that will pay these costs. More on that below in the Medigap section.
Depending on the type of equipment you need, you will typically rent or sometimes be given the option to purchase it.
You should also be aware of Part B excess charges. These arise if doctors bill you more than what Medicare believes a procedure should cost, and they can run up to 15% extra. You can handle this in a number of different ways:
- Avoid these charges by using different doctors
- Pay the charges
- Purchase a Medigap plan that will cover the costs
What DME and Supplies are Not Covered by Original Medicare?
Original Medicare does not cover all DME and supplies that you may need. Durable Medical equipment not covered by Medicare include:
- Equipment designed to assist you outside your home (this could also be a long-term facility, but not a place like a skilled nursing facility)
- Products meant for convenience or comfort
- Non-reusable items or those not used with equipment
- Home modifications
- Equipment not suited for home use
How Does Medigap Cover DME?
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Also known as Medicare Supplement Insurance, Medigap fills in the gap between costs paid by Original Medicare and your healthcare expenses, including coinsurances, copayments and deductibles.
There are 10 different Medigap plans. All but two plans cover 100% of your Part B coinsurance and copayment.
That means, after you meet the Part B deductible ($233 in 2022), you won’t owe anything when renting or buying qualified DME.
There are tow plans that cover your Part B deductible as well, Plan C and Plan F. With these, you would get full DME coverage right away. These plans, however, are only available to those who were eligible for Medicare before 2020.
A popular alternative is Plan G which is just as comprehensive but does not cover the Part B deductible. Plan G also covers Part B excess charges from DME providers that don’t accept Medicare assignment.
If you have questions about Medigap plans to meet your individual needs, call a licensed Ensurem agent at the number on this page.
How Does Medicare Advantage Cover DME?
Medicare Advantage Plans are mandated to at least cover the same services and supplies as Original Medicare Part A and Part B. In fact, some plans may provide extended coverage. Keep in mind that getting a MDE item covered under Medicare Advantage, you may need prior authorization. You may also be required to use providers and suppliers who are in-network.
If you go with Medicare Advantage, your costs will depend on the plan you select. Keep in mind that when enrolled in Medicare Advantage, you will not be able to purchase a Medigap plan to cover coinsurance.
Whether you should choose to stay with Original Medicare, add a Medigap plan or switch to Medicare Advantage to cover your DME depends on your individual situation. If you have questions, we’ve got answers. Call a licensed Ensurem agent at the number on this page, and we’ll help you make the right decisions for your needs.
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Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.
Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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