In addition to covering a wide range of services, Medicare also covers certain medical devices, items and supplies often referred to as durable medical equipment (DME).
The Centers for Medicare & Medicaid Services (CMS) defines durable medical equipment as special medical equipment, such as wheelchairs or hospital beds, that are prescribed by your medical provider for use in your home.
Use this guide to learn more about durable medical equipment, including a list of some of the DME that Medicare covers and the estimated costs you can expect to pay.
Medicare covers a range of items, supplies and equipment as durable medical equipment. The list of DME that is covered by Medicare includes (but is not limited to):
The classification of DME extends to DMEPOS, or durable medical equipment, prosthetics, orthotics and supplies. Items in this classification include prosthetics such as artificial limbs or other body parts, along with things like braces and wound dressings.
In order for durable medical equipment to be covered by Medicare, the item in question must be:
Durable medical equipment is covered by Medicare Part B (medical insurance). Once you meet your Part B deductible ($185 per year in 2019), you are typically required to pay a 20 percent coinsurance for the Medicare-approved cost for your qualified DME.
The following criteria must be met before Medicare will pay for your DME:
Depending on the type of durable medical equipment, you may have to purchase or rent the item.
Depending on where you live, the cost of your DME may be affected by the Competitive Bidding Program.
Under the program, DME suppliers submit a bid to Medicare to supply certain products to Medicare beneficiaries. Medicare then sets the amount it will pay for each item based on these bids.
The federal Medicare website provides a list of areas that utilize competitive bidding, as well as the types of DME that are affected.
Durable medical equipment can typically be obtained from three different types of providers, and each may carry a different cost for the same item.
Be sure to check with your doctor and your DME supplier to find out how much your equipment may cost.
Medicare Supplement Insurance plans, or Medigap, provide coverage for many of the out-of-pocket costs that Medicare Part A and Part B don't cover.
Some Medigap plans can help cover some of the out-of-pocket costs associated with durable medical equipment.
DME costs that may be covered by certain Medigap plans can include:
Learn more about how Medicare Supplement Insurance can help cover durable medical equipment.
By law, Medicare Advantage plans are required to provide at least the same benefits as Medicare Part A and Part B (known together as Original Medicare).
This means that Medicare Advantage plans provide the same coverage for qualified DME as Original Medicare.
Many Medicare Advantage plans also offer a number of benefits not covered by Original Medicare. This includes providing coverage for certain items that can help make it easier for people to age in place at home, some of which are not currently classified as DME and therefore not covered by Original Medicare.
In 2019, some Medicare Advantage plans may now provide coverage for equipment like bathroom grab bars, wheelchair ramps and air conditioners for people with asthma.
Ask a licensed insurance agent what additional benefits may be covered by the plans you are considering.
Are you looking for Medicare coverage for your approved DME? Do you want to find a plan that may also cover additional medical equipment that isn’t covered by Original Medicare? You may be able to find a Medicare Advantage plan that offers the benefits you need.
Call to speak with a licensed insurance agent who can help you compare Medicare Advantage plans that are available where you live.
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