Durable Medical Equipment (DME) is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses. This includes:
- Canes (however, white canes for the blind aren’t covered)
- Blood sugar monitors & blood sugar test strips
- Hospital beds & pressure reducing beds, mattresses and mattress overlays to prevent bedsores
- Traction equipment
- Sleep apnea devices and accessories
- Oxygen equipment and accessories
- Manual wheelchairs and power mobility devices (power wheelchairs and scooters to be used in home)
- Commode chairs
Steps to Obtain Durable Medical Equipment
If you were to need or want any of the pieces of durable medical equipment listed above, your doctor or treating practitioner (like a nurse practitioner, physician assistant, or clinical nurse specialist) must prescribe the type of equipment you need by filling out an order. For some equipment, Medicare may also, require your doctor to provide additional information documenting your medical need for the equipment. If your needs and/or condition changes, your doctor must complete and submit a new, updated order.
If you’re doctor or treating practitioner prescribes a piece of durable medical equipment, depending on the type of equipment and qualifying diagnoses:
- You may need to rent the equipment
- You may need to buy the equipment
- You may be able to choose whether to rent or buy the equipment.
If you are on traditional Medicare or have a Medicare Supplement plan, generally, you pay 20% of the Medicare-approved amount after you pay your Medicare Part B deductible for the year ($198 in 2019). Medicare pays the other 80%. However, the amount you pay may vary because Medicare pays for different types of Durable Medical Equipment (DME) in different ways. If you’re in a Medicare Advantage Plan (like an HMO or PPO), please reach out to the Senior Benefit Services team, each plan covers a different amount, and we can assist you in receiving your durable medical equipment.
Unfortunately, there are some suppliers of medical equipment that try to cheat Medicare by offering expensive power wheelchairs and scooters to people who don’t qualify for these items. Some less reputable providers or suppliers bill Medicare for a more expensive power wheelchair and deliver a cheaper scooter. Ask questions before you get any durable medical equipment, you have the right to know everything about your medical care, including costs to Medicare. Medicare only covers Durable Medical Equipment (DME) if you get it from a supplier enrolled in Medicare. This means that the supplier has been approved by Medicare and has a Medicare supplier number. A supplier enrolled in Medicare must meet strict standards to qualify for a Medicare supplier number. If your supplier doesn’t have a supplier number, Medicare won’t pay your claim, even if your supplier is a large chain or department store that sells more than just Durable Medical Equipment (DME). If you need help in finding an approved durable medical equipment provider, please call the Senior Benefit Services office, 800-627-2768 and we can help you find a company to work with.