How Medicare Covers Durable Medical Equipment

Medicare has a plan which covers certain kinds of durable medical equipment you may need at home. And therefore, if you need these equipment or supplies, it’s imperative that you learn to distinguish what is eligible from what isn’t eligible for coverage. And regardless of whether you have Medicare Advantage Plan or Original Medicare, the requirements of the items to be covered will always remain constant.

How medicare covers durable medical equipment

If you have Medicare part B, it will cover medical items which are considered durable and can be used repetitively. Also known as DME (Durable Medical Equipment), these items are usually required to fulfill certain requirements in addition to being durable.

The following is a summary of how medicare may consider medical items durable and eligible for coverage

– When the equipment is designed to help treat an injury or a medical condition
– When the item is designed for use at home, although it can also be used outdoors sometimes
– When the item is built to last at least 3 years or longer

For those who fall under the category of hospital inpatient or skilled nursing facilities

If your situation is related to any of the two above, then it means your DME will be covered under part A. Examples of the types of DME covered include wheelchairs, walkers, crutches, self-testing equipment for conditions like diabetes, and certain types of nebulizers.

In addition to this, Medicare will be responsible for covering certain prescription drugs and supplies used in combination with the DME. The rule of durability doesn’t apply here since Medicare will cover these items regardless of whether they are disposable or used only once.

If you’re using medication in conjunction with nebulizers, Medicare has a plan for this too. And if you suffer from a medical condition that requires you to use certain items like test strips and lancets, these too will be covered. This is ideal for those suffering from medical conditions like diabetes.

Note for those who want to know how Medicare covers Durable Medical Equipment

Even though the equipment you want to use may be categorized under durable medicare items, you will only have it covered when the doctor says you need it. Also, for Medicare to cover that item, it must have been sourced from a Medicare-approved manufacturer or distributor.

For those who have original Medicare

Medicare runs what we call competitive bidding program for those who have original Medicare and are looking to use DME at home.

Competitive bidding areas are physical locations (zip codes) within the United States. If you travel outside those areas, it will affect the cost and coverage of the plan.  You must use a provider to get the durable medical equipment in the competitive bidding zip code that you reside.  If you reside outside of one of Medicare’s competitive bidding zips then you can get equipment and supplies from any provider, such as Towson Medical Equipment.

Also, most DME items are included in the Competitive bidding demonstration, so you need not to worry about it.  However, in the event that the DME item you are using isn’t covered, you will need to call them or visit the official Medicare website to learn how to go about it.

No comments yet.

Leave a Reply