KEY
POINTS
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Durable medical equipment may not be useful to those who are free of injury and illness.
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Medicare may not cover DME and supplies that are of use outside the home.
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Medicare Part B covers 80% of DME leaving beneficiaries responsible for the remaining 20%.
Durable medical equipment (DME) includes certain medical supplies and medical equipment that a person uses in their home or that allows them to recover at home. Medicare will only cover the costs associated with approved durable medical equipment that meets the specific criteria that Medicare establishes for DME Medicare equipment coverage.
What are the Requirements for Medicare to Cover Durable Medical Equipment?
Medicare covers certain types of medical equipment and supplies that meet the criteria set by Medicare. Part B covers most approved durable medical equipment. Some requirements for coverage include:
- The equipment must be durable to withstand repeated use
- Durable medical equipment must be suitable for use at home, although it may be used outside the home
- The DME is customarily and primarily used for a medical purpose and is medically necessary for you
- It is not useful for individuals who do not have an illness or injury
- It will likely last for at least three years
What Qualifies as Approved Durable Medical Equipment?
Medicare has a long list of equipment and devices on its durable medical equipment coverage page. The agency explains that DME Medicare equipment coverage consists of the medically necessary equipment that a doctor prescribes for you to use in your home. Some examples of DME covered by your Medicare Part B include:
- Hospital beds
- Blood sugar meters and test strips
- Lancet devices and lancets
- Oxygen equipment and supplies
- Infusion pumps and supplies
- Walkers and canes
Other covered items include:
- Continuous passive motion devices
- Continuous positive airway pressure (CPAP) devices
- Nebulizers and nebulizer medication
- Patient lifts
- Commodes
- Pressure-reducing support surfaces
- Medicare also covers prosthetics and traction equipment.
You may be surprised to learn that Medicare covers scooters and wheelchairs but does not cover motorized wheelchairs or scooters that you use primarily outside of the home. Remember that Medicare covers DME for personal use in your home when your medical provider prescribes it.
The Medicare Coverage of Durable Medical Equipment & Other Devices booklet explains that most suppliers who work with Medicare are honest suppliers. However, Medicare beneficiaries may come across suppliers who attempt to cheat by offering power wheelchairs and scooters at a high expense for those who may not qualify for them. Medicare equipment is often rented, do not fall into the trap of purchasing a wheelchair or scooter that is not approved DME equipment.
Does Medicare Cover all Durable Medical Equipment and Supplies?
Medicare does not cover all DME and supplies. The equipment and supplies that Medicare may not cover are those primarily used outside of the home. Those items include:
- Stairway elevators
- Bathtub seats or toilet seats
- Grab bars
- Air conditioners
- Most disposable items such as pads or face masks.
- Most home modifications such as ramps or widened doorways for wheelchairs.
How Do I Find Medicare Suppliers for Durable Medical Equipment?
Medicare provides an improved supplier directory. It allows beneficiaries or their loved ones to have an easier process to find DME covered by Medicare. The supplier directory includes greater functionality and features. The directory page allows users to learn how to use the tool and to search for suppliers in their area.
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