Durable Medical Equipment

Medicare & Durable Medical Equipment Coverage

Medicare Part B provides Durable Medical Equipment (DME) coverage for its beneficiaries. Medicare assists patients that need to rent or buy medical supplies by subsidizing 80% of the price, leaving 20% to be paid by the enrollee.

Medical supplies must meet several standards in order to be covered by Medicare. DME must be prescribed to you by your doctor for home use. To be eligible for coverage, the equipment must be long-lasting, medically necessary, and generally not useful to someone without injuries or disease.

Covered items can include basic supplies such as crutches or canes. More sophisticated equipment such as prosthetic devices or continuous passive motion machines may also be included.

The procedure for receiving these medical supplies will vary depending on where you live and which Medicare plan you are enrolled in. Medicare Advantage may require approval prior to receiving your equipment, and using preferred suppliers and brands will lower your out-of-pocket costs. Check your plan’s requirements before ordering equipment.

Original Medicare beneficiaries have more requirements to meet before their DME will be covered. The Competitive Bidding Program for DME was introduced in July of 2013. This program is in 100 metropolitan areas nationally and was designed to limit supplier fraud and waste. It is projected to save Medicare beneficiaries over $17 billion in out-of-pocket costs in the next decade.

Steps to Obtain Durable Medical Equipment

The first step in obtaining DME for original Medicare enrollees is an office visit with their doctor or other medical professional which discusses the reason for needing supplies. Your doctor must provide you with a statement confirming that the visit occurred and a copy of this statement needs to be included with your supply order.

Next, determine whether you live in one of the regions that participate in the Competitive Bidding Program. You can contact your plan provider or visit the online Medicare Supplier Directory. There will be a list of contracted suppliers who are authorized to rent or sell each type of equipment in your area. It sounds like a complicated process, but it is similar to determining which physicians in your town accept Medicare.

By ordering from a contracted supplier, you may be able to lower your costs and ensure that Medicare will help pay for the purchase or rental of your needed equipment. If your doctor has determined that you require a specific brand of equipment which is not carried by the contracted supplier, the company must work with you to help you find an alternative.

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