Durable Medical Equiptment – What you need to know
Learn Medicare’s rules for Durable Medical Equipment before you need this service
We encourage all Medicare beneficiaries learn the Medicare rules for renting/buying durable medical equipment. Doing this before you actually need this resource (and even selecting a health plan) may help eliminate the anxiety that can be created when this is put off to the last minute. Why do it? Because if will save you money and you can use the system to help you get what you need quickly.
What is durable medical equipment (DME)?
You can find a definition of this term here. Below is a cut/paste of the definition from this source.
“Durable medical equipment is any medical equipment used in the home to aid in a better quality of living. It is a benefit included in most insurances. In some cases certain Medicare benefits, that is, whether Medicare may pay for the item. The item is defined by Title XIX for Medicaid:
The term “durable medical equipment” includes iron lungs, oxygen tents, Nebulizers, CPAP, catheters, hospital beds, and wheelchairs (which may include a power-operated vehicle that may be appropriately used as a wheelchair, but only where the use of such a vehicle is determined to be necessary on the basis of the individual’s medical and physical condition and the vehicle meets such safety requirements as the Secretary may prescribe) used in the patient’s home (including an institution used as his home other than an institution that meets the requirements of subsection (e)(1) of this section or section 1819(a)(1)), whether furnished on a rental basis or purchased, and includes blood-testing strips and blood glucose monitors for individuals with diabetes without regard to whether the individual has Type I or Type II diabetes or to the individual’s use of insulin (as determined under standards established by the Secretary in consultation with the appropriate organizations); except that such term does not include such equipment furnished by a supplier who has used, for the demonstration and use of specific equipment, an individual who has not met such minimum training standards as the Secretary may establish with respect to the demonstration and use of such specific equipment. With respect to a seat-lift chair, such term includes only the seat-lift mechanism and does not include the chair.[1]”
Medicare and Durable Medical Equipment (DME)
We feel the best source for information about Medicare and Durable Medical Equipment (DME) can be found on the CMS and Medicare websites. Please use the resources below as your starting point to learn about and find your answers to specific questions.
Learn what is covered here.
Learn why Medicare switched to a competitive vendor bidding program for certain types of DME and why you should use these vendors (it will save you money). Read this information here.
What you need to think about if you are a frequent user of DME
If you are considering a Medicare Advantage plan (Part C) for your health care coverage, be sure and check what the DME co-insurance/copays are for the plan(s) you are considering.
Be aware certain Medigap plans will pick up your copay for this equipment.
Prior Authorizations for DME
Be aware many Durable Medical Equipment items require ‘prior authorization’ before Medicare will agree to supply the item(s). Learn more the process and which items are included here.
Medicare beneficiaries in assisted living/nursing care facilities
Check to see if these facilities are using DME providers in Medicare’s competitive bidding program
We encourage to not assume people working at these facilities know and understand Medicare’s rules for DME nor keep up on which DME providers that accept Medicare. We have found some of these facilities have their favorite DME suppliers and may not be checking to see if these providers are still in Medicare’s competitive bidding program or still accept Medicare. Like doctors and hospitals, DME providers can be added and deleted from the database (start accepting Medicare or move out of the Medicare program). We encourage you to learn Medicare’s rules for DME and always check if the provider(s) you prefer to use are in the Medicare competitive bidding program.
Is your facility using your prescription drug plan’s network pharmacies
We have found these facilities may not be checking to see if the pharmacies they use (or are changing to) are included in each resident’s Medicare prescription drug plan’s network. It is up to you to verify this. If the facility is not using an ‘in-network’ pharmacy (and a ‘preferred pharmacy’) for your plan, you could be paying more for your prescription medications. What should you do? Research your plan’s pharmacy network and find out if which can meet the requirements of your facility. Inform your facility of these pharmacies and insist they use one of these to provide your med’s.
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