Whether it’s a walker to keep you mobile or a blood sugar meter that helps you stay on top of your own health, durable medical equipment can be key for independence and health. The good news is that Medicare does cover durable medical equipment (DME) through Medicare Part B. We’ll go over what types of equipment Medicare covers, whether to buy or rent DME and how to handle any hiccups that come up in the process.
What to Know About Medicare DME
According to Medicare, durable medical equipment is a device that you need to stay safe or healthy in your home and that you would use repeatedly. For instance, if you have trouble walking, you may need a cane, wheelchair, or scooter to safely navigate your house. If you have sleep apnea, you might need a CPAP machine to help you breathe at night.
But while Medicare does cover DME, it looks at what’s medically necessary, not what would be nice to have. That means that if your DME has an optional feature, you may face some out-of-pocket expenses. For example, your doctor may prescribe a power wheelchair as a medical necessity. Want light-up casters or a special backrest? You’ll probably have to pay for those upgrades yourself.
An upgrade can only be covered if your doctor successfully makes the case that it’s medically necessary for you. For instance, a walker without wheels is the most basic model. But if you don’t have the strength to lift it, your doctor could prescribe an upgrade to a wheeled walker. For this reason, it’s important to make sure your doctor is fully aware of your medical needs before he or she writes the DME recommendation.
Buying vs Renting from Medicare-approved DME Suppliers
For some equipment, like a power wheelchair, you may have the option to rent or to buy.
If you decide to buy upfront, Original Medicare DME coverage pays 80 percent of the purchase price, and you pay 20 percent. If you go for DME rental, Medicare pays 80 percent of the rental cost, and you pay the other 20 percent.
Keep in mind that if you rent for long enough, you’ll probably end up owning the DME by default. After 13 months of rental, Medicare and durable medical equipment suppliers typically transfer ownership to you. Some DME, such as oxygen supplies, are always rented, never purchased, by Medicare. And if an item must be made specially to fit you, rental may not be an option.
Each Medicare Advantage plan follows its own rules regarding DME rental or purchase.
Once you’ve decided whether to rent or purchase your DME it’s important to choose the right durable medical equipment supplier.
For Original Medicare users, your most economical choice is renting or buying from a Medicare-approved supplier. You can find approved DME suppliers on the Medicare website or by calling 1-800-MEDICARE (1-800-633-4227).
It’s also important to ask DME suppliers if they take Medicare assignment. That means they’ve agreed to accept the Medicare-approved amount as full payment for the DME. Those that don’t may charge more than Medicare’s approved cost, and Medicare will only pay 80 percent of its approved cost, regardless of what you pay.
Again, Medicare Advantage plan coverage varies, so if you’re a Medicare Advantage member, you’ll need to check your plan rules to find out how your DME supplier choice may affect your cost. Typically, in-network suppliers and preferred brands offer the most cost savings.
How to Handle Medicare DME Supplier Complaints
Whether it’s an order that didn’t arrive, a customer service issue, or any other problem, the law requires DME suppliers to be responsive to your complaint. Once you’ve alerted your DME supplier to the problem, it has only five days to let you know it’s working to fix the issue. It’s also required to respond in writing within two weeks with its solution.
You can also speak to Medicare about your complaint by calling 1-800-MEDICARE (1-800-633-4227).
Only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a Licensed Sales Agent.
Approved YM04012107
Return to: Medicare In-depth
YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.
