A common question from Home Health Medical customers is, “Does Medicare cover the medical equipment I need at home?” To qualify for coverage, the home medical equipment must be considered durable medical equipment (DME) and medically necessary. Coverage and costs vary per Medicare plan and/or supplier.
Medicare coverage plans
Medicare Part B (medical insurance) is the Original Medicare plan that covers durable home medical equipment. Medicare Advantage Plans (Part C) cover the same items as Medicare Part B, but may have different coverage levels. Check with your provider and equipment supplier to determine your coverage and costs.
What is durable medical equipment?
Durable medical equipment is any reusable medical equipment, such as hospital beds, walkers or wheelchairs. A doctor or other healthcare provider must prescribe DME for your use in the home. Medicare does not usually cover products used in daily living or in the bathroom, such as reachers, wheelchair ramps, shower chairs and tub grab bars.
Durable medical equipment includes, but is not limited to, these home health products:
- Walkers and rollators
- Bedside commode chairs
- Traction equipment
- Wheelchairs, manual and power (capped rental)
- Hospital beds, semi-electric only (capped rental)
- Patient lifts (capped rental)
- Mattress overlays/pressure pads (capped rental)
- Respiratory equipment (oxygen therapy, CPAP, nebulizers) (capped rental)
Is the equipment medically necessary?
Medicare will only cover medical equipment products and services that are considered medically necessary, i.e., are needed for the diagnosis or treatment of your medical condition. For some special equipment, such as home oxygen and patient lifts, Medicare requires a Certificate of Medical Necessity from your physician’s office before coverage is approved.
What will I pay?
Generally, for most home durable medical products covered by Medicare, you pay 20% of the Medicare-approved amount (after deductible) and Medicare pays the remaining 80%.
Rental vs. purchase
You may have the option to rent or buy your medical equipment. It is usually more cost-effective to purchase inexpensive items, such as canes or walkers.
Capped rental applies to more expensive equipment (e.g., semi-electric hospital beds, wheelchairs and patient lifts). Capped rental is Medicare’s version of a “rent to own” program. To qualify for coverage, the equipment must be rented and installed through a Medicare provider/dealer. Medicare pays 80% of the monthly rental fee for up to 13 continuous months of use. You pay the remaining 20% of the monthly rental amount. At 10 months, you may decide to buy or return the equipment. If you decide to purchase, after 13 months, Medicare will discontinue rental payments and, as the owner, you will pay the remaining installments to the supplier. Home oxygen equipment has special guidelines and may be rented for up to 36 months.
Check with your provider and supplier
To ensure Medicare will cover costs of your home durable medical equipment, always confirm that your healthcare provider or supplier is enrolled in Medicare and/or has a Medicare supplier number. If not, you will not receive any Medicare coverage for your needed home medical supplies.
Read more about Medicare coverage for durable medical equipment at http://www.medicare.gov/publications/pubs/pdf/11045.pdf or visit www.medicare.gov.
Medicare coverage may vary by state. To find out if Medicare covers a particular type of home medical equipment, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.