If you are a Medicare member, you might already know that medically necessary Durable Medical Equipment (DME) is an important topic. A DME is covered in Medicare Part B (Medical Insurance). Also, it should be prescribed by a doctor piece of protected equipment or device used at home. This article discusses various clarifications and frequently asked questions regarding DME in Medicare.
First of all, let’s understand what DME is? Any Medical equipment that satisfies the following requirements is covered under a DME by Medicare and other insurance providers :
Long-lasting
- It is used for medical purposes.
- Not useful to those who aren't injured or unwell.
- Used In your own home
- Has a minimum expected lifespan of three years.
Depending on how you obtain the equipment, there are different kinds of payment structures for DME by Medicare. There are three categories of receipt for your DME equipment or Device include
- You might be buying the equipment.
- You might be renting the equipment.
- You have the option to either buy or rent.
The most important thing to check here is the Enrollment status of the Doctor and DME Supplier with Medicare. Enrollment of both is a requirement to cover DME under Medicare. If your DME supplier is enrolled with Medicare and accepts assignments, you can contact them and ask for the costs involved with the above three options.
A brief overview of DME cost:
Medicare Part B covers it, which means that after you've met your deductible, you'll typically pay 20% of the Medicare-approved price. This is known as coinsurance or copayment.
Medicare insurance will cover 80% of the Medicare-approved cost of buying and repairing. You are responsible for the remaining 20%. Your supplier must also be enrolled with Medicare, as we mentioned earlier.
If your doctor orders your DME, Medicare's Competitive Bidding Program may impact your supplier choice. In that instance, you may be required to use a Medicare-approved medical equipment provider.
Your 20% coinsurance for your DME and other out-of-pocket expenditures not covered by Medicare Part B may also be covered by a Medicare Supplement Insurance plan. Find out more about Medicare Supplement Insurance at this link
Which Equipment are covered:
There are three major categories of equipment that are covered. Generic equipment for sleeping and seating, Prosthetic & orthotic items, and Corrective lenses. The list of examples covered and included under DME equipment or device is given on this link.
Medicare usually covers standard medical equipment that fits your health needs. You may have to pay more if you want more features or upgrades.
Supplier Directory:
As we discussed, Medicare will only pay for equipment if the DME supplier participates in the Medicare program. The participating supplier accepts the cost approved by Medicare and will not charge any extra amount. Medicare.gov site maintains a Supplier Directory from where you can find Medicare-participating suppliers.
Durable Medical Equipment in other insurance systems:
Sometimes Medicare or Medicaid won't cover the things you want to have, or you simply don't want to wait to see whether your request is accepted. In any case, there are a few alternative options for financing durable medical equipment:
Veterans' health care: The Department of Veterans Affairs can assist veterans and their spouses with a Medicare copayment for DME or the total cost of DME. Several VA programs are accessible, including CHAMPVA benefits and Tricare.
Private insurer: Durable medical equipment is often covered by private insurers. To learn more about your policy, contact your private insurer directly.
Nonprofit or state assistance: Grants, low-interest loans, assistive technology programs, and financial aid programs are available from some not-for-profit organizations, national foundations, and states to help seniors pay for durable medical equipment. For assistance in identifying available services, go to your state's website or call your local Area Agency for the Aging..
Even without health insurance, paying out of pocket is still possible. You might even discover that it's the quickest way to obtain the necessary tools. If you opt to pay for anything privately that Medicaid, Medicare, or another insurance policy would cover, make sure you understand the cost difference. Please check out businesses like Sky medical supplies and other supplies if you live around Denver, Colorado, when you need medical supplies. Almost all Medical supply stores will provide an honest quote and advice for your DME needs. We provide a variety of medical supplies, including wheelchairs and power wheel chairs, for purchase or rent.