Important Medicare information
Most of the products need to go to the local MDE Supply so
as to bill Medicare for the product that you want to rent or purchase. A lot of
products which include the hospital beds, the respiratory products as well as
some power wheelchairs are just covered as a month to month rental. The recent
Medicare rates cover an average refund of 45% over the product categories.
According to the refund amount which is now offered by Medicare, the supplies
offer an economy product that matches the amount that Medicare will reimburse.
When shopping for a specific product by brand or version name is limited to
what your local supplier offers.
You have to visit a local Medicare supplier/store for
Medicare coverage or for refunds for eligible items. Medicare claims have to be
electronically submitted by your local supplier. Currently most of the time
Medicare will reject paper billing from a beneficiary if the product will be
purchased via the internet.
Read along as we are going to offer you
the best links to Medicare’s pages for getting a product as well as a supplier
within your area that will be capable of billing your Medicare. But keep in
mind that some of the designated suppliers within our area might be around 2000
miles away. The supplies might carry/stock what is known as the economy
products for Medicare billing.
Getting a Medicare supplier within your area
In order to access the Medicare Supplier,
you will have to go to our Directory, enter your zip code then press enter,
then choose the checkbox that is next to the category that you want, then press
the search which is located below the page.
Medicare frequent asked questions and answers
- The assigned and non-assigned claims: The assigned means that there is no out of pocket expenditures while the non-assigned means that you have to make up-front payments that will be refunded back to you.
- Capped rental: This means there is paid as a monthly rental and there is no reimbursable purchase.
- The compression hose: Currently there is no compression hose that is covered by the Medicare program.
- The diabetic shoes and inserts: for the Medicare to cover the Diabetic shoes they have to be fit to your feet and this should be done by the local specialist. Medicare does not allow billing for the shoes that are sold over the internet.
- The hospital beds and the adjustable beds: The hospital beds are normally capped rentals, while the adjustable beds are normally not covered. You will have to recheck with your local store.
- The lift chairs: This covers about a $280 refund (reimbursement). This is filed as a non-assigned claim, and this means that it will require you to pay for an up-front. Contact your local store in case you need your Medicare to cover for the lift chair.
- The patients lift: the patients are normally capped-rentals equipment. Contact your local store for more information regarding rentals.
- The manual Medical wheelchairs: These are also capped rental. All the manual chairs are covered by Medicare in a rental category. You have to contact your local store in case you need your Medicare to cover a manual wheelchair.
- The oxygen concentrators, CAP, and the Nebulizers: This fall under the capped rental category of equipment. For equipment such as the CPAP, Nebulizer, concentrators as well as those related to this category are all covered as capped rentals. You have to visit your local store/supplier who is approved by Medicare so as to bill for Medicare.
- The power wheelchairs: These are currently capped rental. You have to visit your local supplier/store that is approved by Medicare so as to bill for a power wheelchair in case you need one.
- The power scooters are commonly known as the POVs: these are also capped rentals too. You have to visit your local supplier/store so as to bill for a power wheelchair in case you need one. You cannot purchase one via the internet.
- The walkers and rollers: these have to be billed form the local supplier as Medicare will not cover one of purchased via the internet.
Obtaining the Medicare
Q: How can I get coverage for a medical item that I need for
A: Under normal condition, the doctor
will offer a written prescription and this is what is needed, or you can be
offered a dispensing order that is written by your physician who is responsible
for treating you. Some of the items need a well detailed written order before
they are delivered or they need a Certificate of Medical necessity (CMN).
The dispensing order involves the
- A detailed description of the item
- The name of the beneficiary
- The date of the order as well the physician’s signature and
written order should include the following:
- A well-detailed description of the item as well as the
- The full name of the beneficiary
- An ICD-9 diagnosis code
- The order start date
- The time interval of the need
- The physician’s signature as well as the date
The Medicare assignment and the
Q: What is the meaning of assigned and
The assigned means that Medicare will allow the approved fee for the equipment.
Medicare will pay the supplier 80% of the entire approved fee. Secondary
insurance normally covers the remaining 205 that is not covered by Medicare. If
the beneficiary does not have a secondary insurance, then he/she will be
responsible for covering the remaining 20%. The non-assigned means that the
beneficiary has to pay upfront for the equipment and the supply will the file
for the claim to the Medicare. If the claim is valid, then Medicare will refund
the beneficiary by 80% of the approved fee that was paid.
Which equipment is covered by Medicare?
Q: What does Medicare cover?
A: Medicare Plan B
covers durable medical items which include:
manual wheelchairs which are categorized as capped rental
power wheelchairs that are capped as capped rental
of the positioning items
rollators as well as walkers
mattress over-lays which are capped rental
sea-lift mechanisms for the lift chairs
oxygen devices that are capped rental
patient lifts that are capped rental
orthodox and splints
in case you need
Medicare coverage of one of the above-mentioned types of products, you will
have to visit your local dealer that rents/sell the devices as well as bills
the Medicare. A lot of people are surprised to know that the manual wheelchairs
as well as hospital beds to be under capped rental items. These capped rental
items require the dealer to maintain the item over the rental period of 13
months. You have to contact or visit your local supplier so as to get these
The durable medical
items are covered by Medicare only if they are prescribed by the doctor and
comply with the coverage criteria. You will have to find out the equipment that
is covered and if the supplier is approved. You can do this by just calling the
Medicare’s durable medical equipment regional carrier within your area.
Types of products that are not covered by the Medicare
Q: What items are not covered by Medicare?
A: The items which are
not covered by the Medicare includes: the adaptive daily living support such as
the automobile lifts, ramps, the reachers, the sock aids, utensils, shower
chairs, the transfer benches, raised toilet seats, pulse oximeter, gab bars,
and adjustable based beds. Normally the Medicare coverage does not go beyond
the bathroom door.
Medicare coverage in the nursing home
Q: What does Medicare cover in the nursing home or in a
skilled nursing facility?
A: under Medicare Part
A the durable and orthotics medical items are not covered by Medicare. Under
Part B, orthotics is covered. In case you are almost being discharged from a
nursing home or a skilled nursing facility, the medical equipment will be
delivered within two days before you are discharged so as to enable the staff
as well as family to learn on the proper use of the equipment.
The Medicare home coverage
Q: What does Medicare consider as a home?
A: Home Medical
equipment should be ideal to be used in the home. A home is your house,
apartment, assisted living facility, a group of in which you live, a relative’s
home. Some of the facilities are not considered as homes which include a
skilled nursing facility, a hospital or a nursing facility.
The capped rental
Q: What is the meaning of capped rental?
A: For most of the
items that fall under Medicare coverage 80% of the rental cost is covered for
13 months of use. Normally the secondary insurance covers the remaining 20%.
The following are the products that are covered as a capped rental:
respiratory items such as the oxygen concentrators
aid surfaces such as the Low-Air –Loss
pressure and the rotational mattresses
finishes paying for the 13 months use, the supplier is able to transfer the
title of ownership to the beneficiary.
Some of the
respiratory items are rent for long periods of time. The oxygen concentrator
rentals can be covered for up to 36 months.
The Medicare coverage of manual
Q: Does Medicare cover manual wheelchairs?
A: Under normal
conditions, the manual wheelchairs are normally covered by Medicare as a Capped
Rental. This implies that Medicare will pay about 80% of the monthly rental
cost and the beneficiary will be responsible for paying the remaining 20%. In
case the beneficiary has secondary insurance, the remaining 20% will be covered
by the insurance. You can use your local supplier that offers rental services
for chairs and he/she will help you in billing for Medicare monthly rental
fees. Some of the Ultra-lightweight wheelchairs consist of a K0005 billing code
and can be billed like a purchase.
The rollator and walker coverage
Does Medicare cover the rollator and walker?
A: Medicare allows
the rollator and walker in every 5 years. Medicare will cover 80% of the entire
allowed fee approved by Medicare. If you have secondary insurance that covers
the remaining 20%, the reimbursement is almost$125 no matter if your rollator
cost $150 or $350, the reimbursement amount is normally fixed, unless you
qualify heavy duty or for a bariatric walker. Rollators are normally coded as
the walkers which have the ideal accessories such as the seat, hand brakes,
wheels. You will have to visit your local Medicare in case you need help with
rollators as well as walkers.
The doctor prescription
Q: What does the doctor have to prescribe let’s say you
need a rollator?
A: You need a walker
with 4 wheels, a seat as well as handbrakes.
The adjustable bed Medicare coverage
Q: Does Medicare pay or reimburse when it comes to
A: The Medicare
coverage for beds is limited just limited to a semi-electric hospital bed and
the entire hospital beds are covered as a capped rental. Adjustable beds are
not covered by Medicare.
Medicare Coverage for hospital beds
Does Medicare pay or reimburse when it comes to hospital beds?
A: Hospital beds fall under the capped rental
category within Medicare coverage. This implies that a local vendor who rents
the equipment should be used and is responsible for filing the billing for the
monthly fees. Your local dealer is responsible for installing and maintaining
this capped rental equipment. Medicare does not consider some of the equipment
such as the full-electric hospital bed, and other luxury beds to be a medical
necessity. The Medicare coverage is only meant for a semi-electric twin size
The Overbed tables
Q: Does Medicare cover the overbed or the bedside tables?
A: The overbed tables, as well
as the bedside tables, are not categorized as a medical necessity and Medicare
does not cover them.
The respiratory items coverage
Q: Does Medicare cover CPAP, Oxygen Concentrators, and
A: Yes, these and respiratory
products are considered as capped rental via Medicare.
Q: In case I purchase a portable oxygen concentrator will
Medicare refund me?
No, Medicare does not accept for or offer coverage of home oxygen concentrators
as well as additional portable concentrators. In case you need one of these
items you will have to seek a local vendor who rents them and bills Medicare.
The transfer boards
Q: Does Medicare cover for transfer boards?
A: The transfer boards are
considered among the medical necessity equipment for the patients that have a
medical condition that limit their ability to move from their wheelchair to
bed, or toilet. In case you are looking for Medicare coverage for these items
you have to visit your local vendor.
The patient lift coverage
Q: Does Medicare Patient lifts?
A: The patient lifts fall under
the capped rental equipment category. This implies that the supplier that rents
the equipment has to file the bill to Medicare for the monthly fees. Medicare
will reimburse 80% of the rental for a period of 13 months. This coverage is
only for the standard hydraulic manual lift as well as a sling. The power
lifts, as well as the standing lifts, are not covered by the Medicare coverage.
Q: Does Medicare cover stand-up lifts?
A: No, this coverage is just for
the manual/hydraulic patient lift. You can visit the local vendor to rent a
The power wheelchair Medicare coverage
Q: What criteria does Medicare consider for a power
A: Medicare normally
does not pay the entire fees but only a part of the entire fee when it comes to
a motorized wheelchair. A power wheelchair is normally covered when the
following conditions are met:
patient is in such a condition such that without using a motorized wheelchair
the patient is confined to be or chair.
patient’s condition makes a wheelchair a necessity to the patient as the
patient cannot operate a manual wheelchair.
patient is able to safely operate and control a power wheelchair.
A patient who is
regarded as to be in need of a wheelchair is normally in a state where he/she
cannot walk and is experiencing severe weakness in the upper extremities due to
neurological or muscular conditions or disease. In case the documentation does not
offer the medical necessity of a need of a power wheelchair but support the
necessity of a manual wheelchair, then the payment will be based upon the least
costly medically appropriate alternative. But in case the power wheelchair has
been purchased while the manual wheelchair upon which the payment is based is
within the capped rental category, then the power wheelchair will be rejected
as being a medical necessity. Options that are referred to as to allow
beneficiaries to perform leisure or recreational activities are not covered by
The power scooter Medicare coverage
Q: What is the Medicare coverage when it comes to
power-operated vehicles as well as scooters?
A: Medicare covers
the power-operated vehicle when it full fills the following criteria:
patient’s condition does not allow him/her to operate a manual chair.
patient has able to safely operate the wheelchair for the POV.
patient is capable of transferring in and out of the POV and has enough trunk
stability to be able to safely ride and control the POV.
Normally the POVs
are ordered for the patients who are capable of moving around within their home
but need a power wheelchair when they need to move outdoor. POVs will be
rejected as they do not comply with being a medical necessity under such
The POV which is
beneficial in primarily enabling the patient to do leisure or recreational
activities will be rejected as being a medical necessity. In case Medicare
covers a mobility scooter then a wheelchair that is offered at the same time or
subsequently is normally as not being a medical necessity.
Medicare and the lift coverage
Q: Does Medicare cover for a lift chair?
A: In order to have
the Medicare coverage of these items you have to visit a local vendor. Just the
seat lift mechanism that is installed in a lift chair is what might be regarded
as a medical necessity in case the following criteria are met:
The patient should
be suffering from severe arthritis of the knee or hip and must have a severe
seat lift mechanism should be a part of the physician’s means of treatment and
can be prescribed as being a necessity in improving the patient’s condition, or
it has to be arresting or retarding the deterioration of the patient’s
patient must be entirely incapable of standing up using a normal armchair or
any other chair that is found in their home. The patient is incapable of
getting up from the chair, especially the low chair, which is not sufficient to
justify that you need to have a seat lift mechanism. As almost all the patients
who are capable of walking are capable of getting out of the normal chair if
the seat height is set at an appropriate angle as well as the arms.
once the patient stands up he/she will be able to walk.
Medicare coverage of
the seat lift mechanism is limited to a few types that can be smoothly operated
and controlled by the patient. Besides, it should effectively be able to assist
the patient when the patient needs to stand up or sit down without a need for
any other assistance. Medicare coverage is limited to the seat lift mechanism
no matter if it is installed within the chair. Medicare reimbursement ranges
Q: Are diabetic shoes covered by Medicare?
A: Medicare does not
reimburse for or allow the coverage of Diabetic shoes, in case the shoes are
fitted upon your feet by a local Pedorthist or a trained filter. Generally, in
most cases, the process involves heat molding the shoe or inserting it to your
foot so as the foot conditions to be properly treated. Even when using this
personal fitting the must be prescribed by a licensed physician who treats the
foot condition that is resulting from Diabetes. Besides the person who is
fitting and offering the shoes has to be approved by Medicare and should be a
Medicare provider so as to be able to bill for the device. Medicare will pay
for a single pair of shoes and 3 pairs of inserts annually. The patients who
are looking for Medicare coverage of shoes are normally diagnosed with
Will I have to pay a 20% co-payment to Medicare?
A: When you have met your deductible you are required to
pay directly or via supplemental insurance, the remaining 20% of the
Medicare-approved amount. This co-payment might not be dropped by the vendor
unless in hardship conditions and only depending on the case at hand. A vendor
who regularly drops the co-payment might be violating federal law.