Medicare helps pay for specific medical equipment that you may need for your medical practice. However, Medicare rules for coverage are strict and can be confusing.
Durable Medical Equipment (DME) widely known as DME is reusable medical equipment, such as walkers, wheelchairs, or crutches. If you have Medicare Part B, Medicare covers certain medically necessary durable medical equipment if your treating practitioner or physician prescribes it for you to use in your home.
To be covered, the prescribed medical equipment must be:
- Used for a medical purpose.
- Not typically useful if you aren’t sick or hurt
- Used in your home
If you are currently residing in a hospital or nursing home that is providing you with Medicare-covered care, these facilities don’t qualify as your “home.” However, a long-term care facility does qualify as your home. If you are staying in a skilled nursing facility and the facility provides you with durable medical equipment, the nursing facility is responsible for the durable medical equipment.
Where to get Durable Medical Equipment?
If you are enrolled with Original Medicare, you’ll need to get your durable medical equipment from the supplier which is too enrolled in the Medicare program, or Medicare won’t pay for the equipment.
For the lowermost costs, find those suppliers that are listed with “participating,” which means they accept the Medicare-approved cost for the equipment and will not charge you above that particular amount. To find Medicare-participating suppliers, you visit their website i.e. Medicare.gov Supplier Directory.
However; if you live in an area that is part of Medicare’s competitive bidding program, you will need to get equipment from suppliers that are contracted by Medicare. For detailed information on the competitive bidding program, you need to find out if your region is covered or not. If you are in a Medicare Advantage plan and you need durable medical equipment, call your plan provider directly to find out if the equipment is covered and to see how much you will have to pay.
If your supplier accepts assignment, all you pay 20% of the Medicare-approved amount, and the Part B deductible applies.
Medicare pays for different kinds of DME in different ways depending on the type of equipment:
- You required renting the equipment
- It is important for you to buy equipment
- You have an option to choose if you wish to rent or buy the equipment
Medicare will only cover your DME if your doctors and DME suppliers are enrolled in the Medicare program. Doctors and suppliers should be meeting strict standards to enroll and stay enrolled in the Medicare program. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.
It is also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept the assignment. If suppliers are enrolled in Medicare but are not “participating,” they may choose not to accept the assignment. If suppliers don’t accept assignments, there is no limit on the amount of how much they will charge you.