There is so much durable medical equipment covered by Medicare. You can benefit from this coverage if your healthcare provider prescribes it. The provider and supplier have to be Medicare-enrolled.
Durable Medical Equipment (DME) covered under this scheme ranges from large items like hospital beds that can be used at home to small items like devices for monitoring blood sugar.
These items are covered under Medicare Part B. However, you should have it in mind that you’d have to deal with out-of-pocket costs such as deductibles and coinsurance. Durable Medical Equipment is also covered by Advantage plans but the costs vary.
In this article, we will be taking a look at the DME covered by Medicare and those that are not. We will also discuss the out-of-pocket costs involved. Furthermore, we will do a comparison of DME purchase versus rental.
Description of terms
Deductible: This is a yearly out-of-pocket cost that a person has to cover within a period before the patient’s treatment is funded by an insurer.
Coinsurance: This is the self-funded percentage of the overall cost of treatment. This is usually about 20% for Medicare Part B.
Copayment: This is usually a fixed fee that must be paid by the insured person when treatment is ongoing.
What are the DME’s covered by Medicare?
Medicare will only pay for Durable Medical Equipment that is tagged as medically necessary. This confirmation must come from a physician or doctor. The Medicare-enrolled provider may include nurse practitioners, physician assistants, doctors, and clinical nurse specialists. Some of the covered DME are:
- Canes
- Crutches
- Walkers
- Blood sugar test strips
- Blood sugar monitors
- Patient lifts
- Commode chairs
- Pressure-reducing beds
- Oxygen equipment
- Trachea equipment
- Infusion pumps and supplies
- Suction pumps
- Power wheelchairs
- Sleep apnea devices
- Continuous passive motion machines
- Urological supplies
- Neck, back, leg, and arm braces
- Artificial limbs
- Breast prostheses
- Orthopedic shoes
- Costomy bags band certain supplies
- Therapeutic shoes for folks battling diabetes
Medical equipment not covered by Medicare
Supplies and equipment that do not meet the standard of medical necessity by Medicare include:
| DME | Covered | Not Covered |
| Disposables | Gauze and intravenous supplies | Items like catheters |
| Convenience and comfort-related | None | Bathtub seats, air conditioners, grab bars, and stairway elevators |
| Catheters | Only for permanent conditions | Not for temporary conditions |
| Motorized wheelchair | If it is used at home | Not if used outside the home |
| Home modifications | none | Modifications for accessing wheelchair, e.g., widened doorways or ramps |
Out-of-pocket costs for DME
Original Medicare is made up of Part A, hospital insurance, and Part B, medical insurance. DME is covered under Part B for people with original Medicare. Out-of-pocket expenses are about 20% of the cost approved by Medicare. There is also an annual deductible of $198.
Part C, which is also known as Medicare Advantage, is an alternative to original Medicare. All the coverage offered in parts A and B are included in part C. However, deductibles, coinsurance, and copays. Verify with your plan that the DME is covered. If it is, also confirm the cost too.
You may also purchase Medicare supplement insurance known as Medicare Advantage. This covers between 50% and 100% of the out-of-pocket costs of parts A and B including the DME cost.
The other Medicare program, i.e., the Part D does not cover the costs of DME. It is for prescription drug coverage.
Should I rent or buy a DME?
A Durable Medical Equipment may be rented or purchased outrightly albeit most DME’s fall under the rental category. Payment is made by Medicare on a monthly basis but the number of months this payment will be made depends on the item. The cost of repairs is handled by the supplier.
The DME the patient may purchase are the items that aren’t costly such as walkers and canes. If the DME belongs to the patient, replacement and repair costs will be handled by Medicare. There are instances where the patient can decide whether an outright purchase or rental is better.