Mon. Oct 3rd, 2022
DME products

Durable medical equipment (DME) is equipment that aids in the performance of daily tasks. It contains many devices, including walkers, wheelchairs, and oxygen tanks. Medicare often covers durable medical equipment if:

  • Durable, i.e., capable of withstanding repeated usage
  • Provides a medicinal benefit
  • Although it is suitable for use in the home, it can also be used outside the home.
  • And is likely to endure for at least three years.

For Part B coverage, DME must be recommended by your primary care physician (PCP). Part A covers DME if you are in a skilled nursing facility (SNF) or hospital as an inpatient.

Whether you have Original Medicare or a Medicare Advantage Plan, Medicare should cover the same types of medical equipment. Examples of DME consist of:

  • Wheelchairs
  • Walkers
  • Hospital bed
  • Electric scooters
  • Portable oxygen equipment

Medicare Part B also covers the following durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS):

  • Internal prostheses that replace all or a portion of an organ
  • The use of prosthetics, such as artificial legs, arms, and eyes
  • Orthotics, such as stiff or semi-rigid braces for the leg, arm, back, and neck

Certain medical supplies

Medicare also covers prescription medications and supplies used with DME, whether disposable or single-use. Medicare covers drugs used with nebulizers, for example. It also covers lancets and test strips used with self-testing equipment for diabetes.

Durable medical equipment contains reusable medical devices and supplies, such as a hospital bed at home or an artificial limb. Contrary to durable medical equipment, single-use medical equipment such as bandages or incontinence pads.

It is essential to comprehend what qualifies as DME and does not, as this impacts insurance coverage. Most public and commercial health insurance plans pay all or a portion of the cost of durable medical equipment.

  • To qualify as medical equipment:
  • Serve primarily as a medical function
  • Be prescribed or ordered by a healthcare professional
  • Be capable of being utilized repeatedly.
  • Typically have a minimum projected lifespan of three years.
  • Use within the house.

Useful only for those with an injury or impairment

These are the most prevalent types of durable medical equipment used outside of hospitals:

  • Kidney machines
  • Traction equipment
  • Orthotics
  • Prostheses
  • Concentrators of oxygen, monitors, ventilators, and related equipment
  • Assistive devices for personal care, such as bath chairs, dressing aids, and commodes
  • Aids for mobility such as walkers, crutches, crutch substitutes, wheelchairs, and scooters
  • Bed equipment like medical beds, pressure mattresses, bili lights and blankets, and lift beds

Are hearing aids enduring medical devices?

When reviewing the criteria for durable medical equipment, hearing aids appear to be eligible. After all, you wear them daily, and they have a lifespan that exceeds three years. Unfortunately, they do not qualify as DME.

Hearing loss affects 25% of individuals aged 65 to 75 and 50% of those aged 75 and beyond; however, hearing aids are still not considered durable medical equipment and are not covered by Medicare or most private insurers.

Hearing aids are categorized as Class I or optional medical devices. Class I medical equipment is not medically necessary by definition. Hearing aids do not qualify since DME only covers medically necessary equipment. If you are concerned about the expense of hearing aids because they are not considered Medicare-approved durable medical equipment.

Does Your Health Insurance Cover This?

If a private plan covers you, you may be insured. The government does not mandate that commercial insurers provide DME coverage. You must evaluate the parameters of your strategy to determine whether or not it does.

Many plans that do include DME have coverage limitations. They may ask that you get your equipment from an authorized vendor. The majority maintain supplier databases on their public-facing websites.

Others may not impose a requirement but may have favored brands. If you purchase from a non-preferred vendor, you may be subject to additional rates or fees. Whenever possible, you should purchase a product from a favored brand.

You can reduce future expenses by renting equipment rather than purchasing it. It is possible to rent hospital beds. Consult your physician to determine if this is an option for you.

What is DME, then?

When preparing for home health care, individuals have a multitude of questions. What exactly is DME?

It is adaptable and durable medical equipment that improves the quality of life. Complementing hospital beds and glucose monitors are wheelchairs and scooters.

Does Medicare pay for this? Original Medicare and Medicare Advantage both offer coverage. However, a patient must have a prescription to obtain it.

Coverage by private insurance? The majority of plans cover wheelchairs and mobility devices.

What other alternatives exist?

While DME Providers offer products that are typically covered by Medicare and Medicaid and typically work with insurance companies to handle payment, multiple mobilities, and accessibility equipment providers exist to fill the void for equipment that is typically not covered by insurance or for individuals who do not meet the eligibility requirements for DME use.

Accessibility and Mobility Equipment suppliers supply items such as stairlifts, lift chairs, ramps, power scooters, and vertical platform lifts for residential use. This equipment assists with typical age-related difficulties, such as ascending and descending stairs, standing up, and walking long distances. The majority of these enterprises sell directly to consumers, bypassing insurance entirely.

Although out-of-pocket expenditures for such devices may deter some buyers, it is crucial to consider the alternative costs of moving into a new house, entering an eldercare facility, or incurring medical and emotional costs due to a fall.

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