Does Medicare Cover Durable Medical Equipment (DME)? | GoMedigap
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Does Medicare Cover Durable Medical Equipment?

Durable Medical Equipment

As we age, our quality of life depends on a variety of aspects. Lack of mobility, ability to breathe without additional help, and other factors greatly impact our day-to-day. Thankfully, Durable Medical Equipment can aid the growing need for physical support.

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 is doctor prescribed and must meet a list of qualifications and criteria before a doctor or supplier considers it DME. 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

Common forms of DME include wheelchairs, walkers, bath safety products, nebulizers, and more. The use of these products is essential for common tasks such as walking, bathing, or breathing.

When defining DME, it is also important to define what is not considered DME. All disposable items such as bandages, needles, and gloves are not considered DME. These items are only good for one use and do not fall under the “expected lifetime of three years” criteria. While these types of items may be essential in your daily life, a doctor cannot prescribe them, nor can they be in this category.

Where Can I Get Durable Medical Equipment?

After your doctor provides you with a prescription, they will often tell you where you can pick up your DME. However, there are some online tools available to help you with your search.

The Medicare.gov site has a tool you can access here. To find DME 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 are looking for.

As always, if you are 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.

Note: Only a supplier enrolled in Medicare can provide you with DME.

Does Medicare Cover My Durable Medical Equipment?

If you enroll in Medicare Part B (Medical Insurance), your Medicare plan covers your 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 are in a nursing home or facility, this does not qualify as a “home” under Medicare, even if it is 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 are in a skilled nursing facility, they might provide you with DME. In this scenario, the facility is responsible for all of your DME.

What Do I Pay?

 For most standard DME such as walkers, CPAP machines, crutches, commode chairs, canes, wheelchairs, and more, you will pay 20% of the Medicare-approved amount. You must first meet and pay your Part B deductible for the year. The amount you pay may vary depending on if you rent or buy the equipment, if renting is an option.

For prosthetic and orthotic items such as ostomy bags, artificial limbs and eyes, orthopedic shoes, cochlear implants, and more, you will pay 20% of the Medicare-approved amount once you pay your annual Part B deductible. If your supplier does not accept assignment (meaning, they do not accept the Medicare-approved amount as full-payment), these costs may be different.

For corrective lenses (prosthetic lenses such as cataract glasses or glasses/contact lenses after surgery with an intraocular lens), Medicare covers one pair of glasses or contact lenses after surgery. You will pay 20% of the Medicare-approved amount once you pay your annual Part B deductible. If your supplier does not accept assignment, these costs may be different.

If you have a Medicare supplement (Medigap) plan, it will cover its respective portion of the 20% gap that Medicare does not pay. This will depend on which Medigap plan you have. For more information on what is covered by your Medicare supplement plan, please see our Medicare supplement plan comparison chart.

How GoMedigap Can Help

Copayments and coinsurance can quickly become pricey, depending on the amount of DME you need. Thankfully, a Medigap plan helps cover those costs for you. For example, Original Medicare might charge you a large amount for your DME. If you had Medicare supplement Plan F, you would pay nothing for your DME. Plan F would cover all of the costs that Medicare does not pay, or the “gaps” in Medicare.

If you have any questions about how a Medigap plan can help you pay for the equipment you need, contact one of our friendly and knowledgeable agents at (800) 310-2550 and they will be more than happy to assist.

Compare Your Medicare Supplement Rates Immediately!

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