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Does Medicare Cover Durable Medical Equipment?

Yes, Medicare covers Durable Medical Equipment in many cases. If you enroll in Medicare Part B (Outpatient Medical Insurance), your Medicare plan covers your Durable Medical Equipment, also referred to as DME. For Medicare to cover DME, a doctor must deem it medically necessary, and you must have a prescription for in-home use.

If you’re in a nursing home or facility, this doesn’t qualify as a “home” under Medicare, even if it’s a Medicare-covered facility. However, if you are in a long-term care facility, this does qualify as a “home” and you can receive your covered benefits. Additionally, if you’re in a skilled nursing facility, they might provide you with DME. In this scenario, the facility is responsible for all of your DME.

What is Durable Medical Equipment (DME)?

Durable Medical Equipment, or DME, refers to any and all medical devices used inside the home to help everyday life. All DME needs to be doctor prescribed and meet a list of qualifications and criteria. This means that the equipment must be:

  • Durable
  • Used for a medical reason
  • Not usually useful to someone who isn’t sick or injured
  • Used in your home
  • Expected to have a lifetime of three years

The use of these products is essential for common tasks such as walking, bathing, or breathing. Medicare durable equipment coverage includes (but isn’t limited to) items such as:

  • wheelchairs
  • walkers
  • bath safety products
  • some insulin pumps
  • nebulizers
  • CPAP machines
  • your first pair of glasses after cataract surgery
  • artificial limbs
  • ostomy bags

Disposable items such as bandages, needles, and gloves aren’t considered DME. These items are only good for one use and don’t fall under the “expected lifetime of three years” criteria. While these types of items may be essential in your daily life, a doctor can’t prescribe them. Instead, you may find that your Medicare Part D Prescription Drug plan covers these items. You can check with your provider directly for more details.

Where Can I Get Approved Medicare Durable Medical Equipment?

After your doctor provides you with a prescription, they’ll often tell you where you can pick up your DME, or you can use Medicare’s online tool. To find durable medical equipment covered by Medicare in your area, simply enter your zip code and the corresponding criteria, and it will generate a list of stores or pharmacies that offer the exact equipment that you’re looking for.

Only suppliers that are enrolled in Medicare can provide you with covered DME. Many pharmacies participate, and they can assist you in purchasing your equipment.

As always, if you’re still having problems finding the right DME for your needs, reach out to your doctor or service provider to get more information on where to get the equipment for you.

If My Item Falls Under Medicare DME Coverage, Do I Pay Anything?

If you have only have Original Medicare, you’ll have some out-of-pocket costs for your Durable Medical Equipment. You’ll need to meet your Medicare Part B Deductible ($198 in 2020), and pay 20% coinsurance. If the provider doesn’t accept Medicare assignment, you may also be charged an additional 15%. Your costs may vary depending on whether you rent or buy.

Fortunately, if you have a Medicare Supplement plan, you may not have to pay anything out-of-pocket. Medicare Supplement Plan F and Plan G are two of the more popular plans, and cover your Medicare Part B coinsurance. Coinsurance can quickly become pricey, depending on the amount or type DME you need, so it’s wise to consider your options for insurance.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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