Does Medicare Cover Durable Medical Equipment?

Medicare, the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease, provides coverage for a wide range of medical services and supplies. Among these are durable medical equipment (DME) which includes items such as walkers, wheelchairs, and home oxygen equipment that are prescribed by a doctor for home use.

Coverage Under Original Medicare (Part A and Part B)

Original Medicare is made up of two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Part B of Original Medicare covers a variety of DMEs if they are deemed medically necessary and prescribed by a Medicare-enrolled doctor. The coverage typically includes 80% of the Medicare-approved amount for the equipment, while the patient is responsible for the remaining 20% after the Part B deductible is met.

To qualify for coverage, the equipment must be:

• Durable, meaning it can withstand repeated use
• Used for a medical reason
• Not usually useful to someone who isn’t sick or injured
• Used in your home
• Likely to last for three years or more

Common items covered under Part B include:

• Blood sugar monitors and test strips
• Commode chairs
• Crutches
• Hospital beds
• Oxygen equipment and accessories
• Patient lifts
• Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices
• Suction pumps
• Walkers
• Wheelchairs and scooters

Part A may cover certain types of DME under specific circumstances. For instance, if you are in a hospital or skilled nursing facility (SNF), the cost of certain equipment might be included as part of your stay.

Coverage Under Medicare Advantage (Part C)

Medicare Advantage Plans, also known as Part C, are an “all in one” alternative to Original Medicare. These plans are offered by private companies approved by Medicare and must provide at least the same level of coverage as Parts A and B but can offer additional benefits.

Regarding DME, Medicare Advantage Plans must cover everything that Original Medicare covers but may offer additional items or services. For instance, some plans may cover more types of equipment or more of the cost than Original Medicare. The specifics, however, can vary greatly between different Medicare Advantage Plans. It is important to review a plan’s benefits before enrolling to understand the DME coverage specifics.

With Medicare Advantage Plans, the costs to you for renting or buying DME may be different and could include a monthly premium and possibly a deductible or coinsurance for the equipment.

Key Differences in Coverage

While both Original Medicare and Medicare Advantage cover durable medical equipment, there are key differences to consider:

• Approval Process: Getting approval for DME can differ. Original Medicare has specific criteria that must be met, while Medicare Advantage Plans may have their own rules and may require pre-authorization for certain types of equipment.
• Costs: Costs can vary between the two options. With Original Medicare, you’re typically responsible for 20% of the Medicare-approved amount, while Medicare Advantage Plans might have different cost-sharing structures.
• Choice of Suppliers: Under Original Medicare, you may have more flexibility in choosing suppliers, while Medicare Advantage Plans might have a network of preferred suppliers you are encouraged or required to use to receive full coverage.
• Additional Coverage: Medicare Advantage Plans may offer additional benefits and cover more types of DME than Original Medicare.