Medicare Coverage of Durable Medical Equipment (DME)
Before discussing how Durable Medical Equipment is covered under Medicare, it is important to understand what is considered to be Durable Medical Equipment. Durable Medical Equipment or DME, is reusable medical equipment such as walkers, wheelchairs, hospital beds, and oxygen equipment. Anyone who has Medicare Part B can get DME as long as the equipment is medically necessary.
Original Medicare and DME
Part B covers DME when a health care provider prescribes the equipment for use in your home or a long-term care facility. If you are in a skilled nursing facility as part of a stay covered under Medicare Part A, the facility is responsible for providing any DME that is needed during that stay up to 100 days. Medicare will only cover DME if it is from a supplier that is enrolled in Medicare, meaning that they have met the strict standards and have been approved by Medicare.
What You Pay
Generally, you would be responsible for 20% of the Medicare approved amount after you have met the Part B Deductible for the year. This can vary however, because Medicare has pre-approved amounts they will pay for items and services and if the supplier or provider does not accept assignment they can bill more. Assignment just means that the provider or supplier has agreed to accept the Medicare-approved amount. The amount that you pay can also vary because Medicare pays for different types of DME in different ways, and you may be able to rent or buy the equipment.
What If You are on a Medicare Advantage Plan?
Medicare Advantage Plans must have at least the same coverage as Original Medicare when it comes to medically necessary items and services. Your specific cost share will depend on the Medicare Advantage Plan that you have, and each insurance carrier will have specific suppliers that they contract with or in other words, that are “in network” with their plans. If you are currently on a Medicare Advantage Plan, you can find the cost-sharing obligation for all Medicare covered services in the “Evidence of Coverage” and if you are considering a new Medicare Advantage Plan it is always a good idea to make sure that plan will cover any DME items or services you are currently using.
When it comes to Medicare and DME, there are quite a few questions that can arise. From whether or not a supplier is enrolled in Medicare, does the supplier accept assignment, or is this supplier in network with my Medicare Advantage plan? Our agents here at VibrantUSA are here to help find the answers to these or any other questions you may have.