| Thu, Jan 24, 2013 @ 09:00 AM

Medicare and Durable Medical Equipment (DME)

Posted by Medicare Made Clear

1hDME—as Defined by Medicare

Durable medical equipment, or DME, is reusable medical equipment that has been deemed medically necessary. Your doctor or another health care provider determines what equipment you need per Medicare guidelines. He or she assesses your health condition, what equipment can be used in your home and what equipment you are able to use.

To be covered by Medicare Part B, DME must also be:

  • Used because of an illness or injury
  • Able and necessary to be used at home (though you may use it outside your home)
  • Likely to last for three or more years
  • Provided by certain medical suppliers approved by Medicare

Note: If you live in a long-term care facility, then that’s considered your home by Medicare. However, if you are in a skilled nursing facility, then that facility is responsible for any DME it provides you.

Some examples of DME are walkers, hospital beds, home oxygen equipment, diabetes self-testing equipment (and supplies), and certain nebulizers and their medications (non-disposable). Wheelchairs and power scooters are also included in the list of DME, but additional rules apply. (See below.)

Generally speaking, Medicare pays for only one piece of DME for a particular health condition at any one time. Also, Medicare usually only pays for the most basic form of the equipment that’s needed.

Wheelchairs and Scooters

Medicare may help pay for your manual wheelchair if all of the following conditions are met:

  • Your health makes it hard to move around in your home. This means that even with the help of a walker or cane, you have significant problems in your home performing activities of daily living. These may include getting to the toilet, getting in and out of a bed or a chair, bathing and dressing.
  • You can safely use the wheelchair yourself, or you always have someone with you to help you use it.
  • Your doctor signs a written order for the equipment. You usually need to have a face-to-face examination with your doctor before he or she approves the order.
  • You get equipment from a Medicare-approved supplier.

Medicare will only help pay for a scooter or power wheelchair for you if:

  • You meet all the conditions for a manual wheelchair (see section above).
  • You are unable to use a cane, walker or manual wheelchair, but are able to safely use a scooter or a power wheelchair.

Other Medical Supplies

In most cases, Medicare does not cover disposable medical supplies that are used once and then thrown away. However, some are covered, supplies like test strips for diabetes. Some diabetes supplies are also covered under Part D. Also, if you qualify for Medicare home health, Medicare may cover certain disposable supplies, such as intravenous supplies, gauze or catheters.

Sometimes, DME is referred to asDMEPOS” because Medicare also covers prosthetics, orthotics and certain supplies, or “POS.” Prosthetics are devices that can replace a missing body part, such as a hand or leg. Orthotics are equipment like braces that help to support or correct the malfunction of a limb or torso.

DME and Medicare Coverage

Original Medicare’s Part B covers DME when your Medicare-enrolled doctor or health care provider prescribes it for you to use at home. Once you have the doctor’s prescription, you can take it to any Medicare-enrolled supplier. Medicare pays 80 percent of its approved amount (after you meet your Part B deductible), and then you (or your Medicare Supplement insurance) pay the 20 percent balance. If your health condition changes and you need a different type of equipment, then you usually need a new prescription from your doctor for it to be covered.

Medicare Advantage (Part C) plans are required to cover everything that Original Medicare covers. This is true for both DME and other benefits covered by the plan. The main difference between Original Medicare and Medicare Advantage lies in how you get DME covered. For example, a Medicare Advantage plan may require prior authorization in order for DME to be covered. You may also need to use a doctor and a DME supplier who are in the plan’s network.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Medicare Part B Coverage—MedicareMadeClear.com

Medicare Coverage of Durable Medical Equipment and Other Devices (PDF)—Publications from the Centers for Medicare & Medicaid Services (CMS) on Medicare.gov

Y0066_130114_104031 CMS Accepted