Understanding Coverage for Durable Medical Equipment
October 7, 2021 | Tom Peterson
What qualifies as durable medical equipment? What type of durable medical equipment (DME) is covered by Medicare? How much will DME cost me? These are questions you might have when figuring out which Medicare plan is right for you. We’ll answer those questions below – but if you need additional help, please schedule an appointment with one of our Twin Cities insurance brokers.
What is Considered Durable Medical Equipment (DME)?
Durable medical equipment is any type of medical equipment that you use to at home to aid in your quality of living. DME has to have a medical purpose as its primary function.
These types of equipment must also be intended for everyday use. It doesn’t include equipment that is used for a short period once or twice per week. DME also aren’t items that you only use once.
The equipment must also be reliable, and should be able to withstand multiple uses. DME usually has a life expectancy of at least 3 years.
Types of Durable Medical Equipment
The types of DME that Medicare will cover include (but aren’t limited to):
- Blood sugar monitors
- Canes
- Commode chairs (toilet chairs)
- CPAP devices (Continuous Positive Airway Pressure)
- Walkers
- Wheelchairs
- Electric scooters
- Patient Lifts
- Oxygen equipment & accessories
DME Costs in Medicare
There are a few things to consider when determining how much you’ll pay for coverage.
Medicare will pay for different kinds of DME, depending on:
- If you need to rent the equipment;
- If you need to buy the equipment; or
- If you can choose between buying or renting the equipment.
Your DME suppliers must participate in Medicare, and must also have to accept assignment. This means they can charge you only the coinsurance and Part B deductible for the Medicare-approved amount.
If your supplier isn’t enrolled and hasn’t accepted assignment, there is no limit on how much they can charge you. So it’s a good idea to confirm they have accepted assignment. Talk to your doctor or health care provider for more information on how much your item, test, or service may cost.
If you are prescribed DME, reach out to your doctor or a qualified insurance agent to ensure that your DME is covered by your Medicare plan.
Choosing a Medicare plan can be difficult. Working with an insurance broker can help you find a plan that fits your needs. Schedule a one-on-one meeting with one of our insurance brokers to get your insurance questions answered!