If your doctor or other health care practitioner tells you that you need durable medical equipment, he'll submit the necessary forms to Medicare for you. You'll need to find a Medicare-approved supplier. The staff at your doctor's office can usually tell you what local companies supply durable medical equipment, or you can contact Medicare.
The Basics
The Centers for Medicare and Medicaid Services defines durable medical equipment as "Medical equipment that is ordered by a doctor (or, if Medicare allows, a nurse practitioner, physician assistant or clinical nurse specialist) for use in the home." Facilities that provide mostly skilled nursing care that's covered by Medicare aren't considered to be "home," and if they provide durable medical equipment to you, they're responsible for it. A long-term care facility can be considered to be your home, if you aren't receiving Medicare-covered skilled nursing care there. For example, an assisted-living home could qualify as your home for Medicare purposes.
Durable medical equipment is covered under Part B of Medicare. It must be reusable, and includes items such as hospital beds, walkers and wheelchairs. Medicare Advantage Plans cover the same equipment as Medicare's original plan. You should call your plan administrator for information about what's covered and the amount you'll need to pay.
If you're already using durable medical equipment under the original Medicare and you decide to switch to Medicare Advantage, call the number for your new plan and ask to speak to Utilization Management. They'll be able to tell you whether your equipment is covered and how much you'll have to pay.
Getting Durable Medical Equipment
Medicare requires that a doctor or other person who's treating you (such as a nurse practitioner or physician assistant) prescribes durable medical equipment for you when needed. For some equipment, Medicare also requires a Certificate of Medical Necessity. The doctor or other practitioner is responsible for submitting this form to Medicare.
Medical equipment suppliers must be enrolled in the Medicare program. They must be approved by Medicare and have a supplier number. You can find approved suppliers online at the Medicare website or call 1-800-MEDICARE. Suppliers work with doctors' and practitioners' offices to make sure that Medicare receives all the necessary paperwork for your equipment.
Your Share
In general, Medicare pays 80 percent of its approved amount for durable medical equipment, after you pay your co-payment, and you pay the remaining 20 percent. Under the original Medicare plan, the approved amount is what Medicare pays to a participating doctor or medical equipment supplier, and it might be less than their usual charge. Medicare pays whichever is lower, the approved amount or the actual charge.
Your payments can vary depending on the way Medicare pays for the equipment. In some cases, you'll rent it, but in others, you'll be able to buy it.
Covered Durable Medical Equipment
The following is a list of covered durable medical equipment taken from the publication "Medicare Coverage of Durable Medical Equipment and Other Devices", from the Center for Medicare and Medicaid Services:
Air fluidized beds
Blood glucose monitors
Bone growth (or osteogenesis) stimulators *
Canes (except white canes for the blind)
Commode chairs
Crutches
Home oxygen equipment and supplies *
Hospital beds
Infusion pumps and some medicines used in them
Lymphedema pumps /pneumatic compression devices *
Nebulizers and some medicines used in them (if reasonable and necessary)
Patient lifts *
Scooters
Suction pumps
Traction equipment
Transcutaneous electronic nerve stimulators*
Ventilators or respiratory assist devices
Walkers
Wheelchairs (manual and power)
Items marked with an asterisk (*) require a Certificate of Medical Necessity.
A scooter or power chair will be covered only if your doctor certifies that it's medically necessary. It's not covered if you only use it outside your home.
Tags: durable medical, medical equipment, Medicare pays, approved amount, doctor other
