Medicare Coverage for Durable Medical Equipment

Medicare recognizes durable medical equipment or DME as reusable medical equipment that is considered medically essential. A doctor or other provider of health care decides which equipment you need by Medicare criteria. He or she examines your health status, the equipment you can use in your home, and the equipment you are capable of using. Part B provides Medicare coverage for durable medical equipment which is medically essential if you reach their conditions.

Durable medical equipment must fulfil the following criteria to get coverage through Medicare Part B:

  • Your doctor or specialist recommended
  • Used by disease or wound
  • Accessible and sufficient to use at home (though you may also be utilizing it outside your residence)*
  • It is probably going to last three or more years
  • Supplied by Medicare-approved medical suppliers

*NOTE: If you stay in a long-term care facility, then Medicare considers that place as your home. However, if you stay in a skilled nursing facility, then that place is accountable for any DME it gives you.   

Medicare Coverage for Durable Medical Equipment

While the following list is not complete and other things may include, the following are some examples of common durable medical equipment items that Medicare Part B commonly provides.

  • Glucose Monitoring System and its components
  • Canes
  • CPAP machines
  • Crutches
  • Hospital Beds
  • Infusion Pumps
  • Nebulizers and their medications
  • Oxygen concentrator and its components
  • Scooters
  • Pressure-relief mattresses 
  • Prosthetics, orthotics (ex. brace), and supplies
  • Suction Pumps
  • Walkers
  • Wheelchairs

Medicare also provides some treatments, drugs, and supplies that are not included in the list mentioned above, which you may need on your long-term medical devices.

Which Items Does Medicare Not Cover?

Medicare does not cover certain types of durable medical equipment and supplies.

  • Material that changes your home like wide doors or ramps
  • Outdoor equipment
  • The client cannot get Paraffin bath units because they are not suitable for indoor use. The exceptional structure of a paraffin bath is for clinics.
  • Luxury Things 
  • Single-use items

Wheelchairs and Scooters

Medicare may help you to get a manual wheelchair if you meet their terms and conditions.

The following are the terms and conditions:

  • If your strength makes it difficult to move around in your residence, you need a helper to move from one place to another. 
  • You may use the given wheelchair yourself if you can, or a helper can help you to move your wheelchair.
  • Your doctor signs the letter of approval for the wheelchair. You have to go to your doctor for a face-to-face examination with your doctor, so after assessing your health condition, he or she approves the equipment.
  • You obtain your wheelchair from a Medicare-approved provider.   

Medicare will only provide you with a motor scooter or electronic wheelchair for you if:

  • You fulfil all the manual wheelchair requirements (see the section above).
  • Your health condition is not letting you use a cane, walker, or manual wheelchair, but allowing you to use a scooter or electronic wheelchair.

The Method That Medicare Follows to Do Coverage

If your Medicare-enrolled doctor prescribes your durable medical equipment items, Medicare Part B will give coverage for it. Once you get a prescription from Medicare-approved doctors, you can obtain your equipment from any Medicare-approved supplier. Medicare pays 80% (after you fulfil your Part B deduction) of the allowed amount, and then you pay the rest 20 percent.

When you change your health and use some form of equipment, you usually have to have a new prescription from your doctor to cover it.

Medicare Advantage (Part C) plans cover everything, which original Medicare provides the coverage. This applies to both durable medical equipment and perquisites supplied by the plan. Original Medicare and Medicare Advantage are primarily distinct because of the procedure in which durable medical equipment is covered. For instance, a Medicare Advantage plan may require prior permission to cover items.