Durable Medical Equipment

Durable medical equipment refers to things like canes, wheelchairs, hospital beds (for home use), diabetic testing equipment, oxygen tanks, walkers, and so forth. Durable medical equipment is usually related to and necessitated by your medical condition.

What durable medical equipment will Medicare pay for? Durable medical equipment is covered under Medicare Part B. Essentially, any equipment that is “medically necessary” will be covered. It must be prescribed by your doctor or other qualified provider such as a physician’s assistant or nurse practitioner. It must also be prescribed for usage in your home. If you are in a nursing home or skilled nursing facility, the facility itself will be responsible for the durable medical equipment. Please note, the durable medical equipment must be purchased or rented from a Medicare-qualified provider.

Medicare has some special rules for certain durable medical equipment. For example, scooters and power wheelchairs will not be covered if they will only be used outside of the home. Durable equipment must be for home use. There are also new rules for the rental of oxygen equipment. Medicare covers a wide range of durable medical equipment including: braces, therapeutic shoes, ventilators, walkers, wheelchairs, blood glucose machines, and other devices. Consult Medicare.gov for further information.

What is the cost of durable medical equipment under Medicare? The basic rule is that you pay 20% of the Medicare-approved amount after paying the deductible for that year (e.g., in 2009 it was $139). This amount is the price that Medicare deems a reasonable cost for the durable medical equipment. The supplier of the durable medical equipment may or may not charge you the Medicare-approved amount. If it does accept that amount, it is called “assignment” but if it does not, you may be responsible for 20% plus whatever cost the supplier layers onto the transaction. Be very careful when selecting a durable medical equipment supplier. Unlike doctor’s office which cannot charge over the so-called “limiting charge”, durable medical equipment suppliers can charge as much as they see fit. Also double check that the supplier is enrolled in Medicare, if it is not it won’t pay anything and you could be left with a large bill.

Medicare Advantage vs. Original Medicare. As discussed in my article on Medicare Advantage, Advantage plans let insurance companies decisions about your coverage within the bounds of the plan agreement. You will have to contact “Utilization Management” at your Medicare Advantage insurance company for further details about what is covered. If you are in Original Medicare (Part A, B, or both) then you will have to get your doctor’s office to fill out a “certificate of medical necessity”. Your supplier will then work with you and your doctor to see if all requirements are met. If your prescription changes for any reason you will have to fill out another certificate of medical necessity.

You can find more information on durable medical equipment at Medicare.gov.