Durable Medical Equipment Coverage - Trusted Senior Specialists

Durable medical equipment (DME) is supplies and materials that can be reused, like crutches, walkers, or wheelchairs. 

If you’re enrolled in Medicare Part B, Medicare covers specific DME that is “medically necessary” — if your physician prescribes it for you to use at home.  

What Is Meant By “Medically Necessary”? 

When a Part of Medicare covers something medically necessary, the health care supplies or services are needed to diagnose or treat the following:

• Injury
• Illness
• Disease 
• Condition, or
• Symptoms of the above 

The supplies or services must also adhere to the approved standards of medicine. 

What Does Medicare Part B Cover?

Medicare Part B is your medical insurance. It covers some doctors’ services, medical supplies (DME), outpatient care, and preventative services. 

Durable Medical Equipment Criteria

Your doctor is the only one who can prescribe DME for you. The medical equipment meets these criteria:

• Used in your home
• Used for a medical reason
• Durable (can endure repeated use)
• Usually has an expected lifetime of at least 3 years
• Not typically useful to a person who isn’t sick or injured

Examples of Durable Medical Equipment

The reusable equipment that Medicare covers includes, but is not limited to: 

• Canes
• Walkers
• Crutches
• Patient lifts 
• Hospital beds
• Suction pumps
• Commode chairs
• Traction equipment 
• Blood sugar monitors 
• Blood sugar test strips
• Lancet devices & lancets
• Wheelchairs and scooters 
• Infusion pumps & supplies
• Oxygen equipment & accessories 
• Nebulizers & nebulizer medications
• Continuous passive motion devices 
• Pressure-reducing support surfaces 
• Continuous Positive Airway Pressure (CPAP) devices 

Reminder: Your physicians and DME suppliers need to be enrolled in Medicare for your equipment to be covered. Physicians and suppliers must meet rigid standards to join and stay enrolled. Before you get DME, ask your suppliers if they take part in Medicare. 

Your Costs in Original Medicare

If suppliers participate in Medicare, they have to accept assignment. So, you pay 20% of the Medicare-accepted amount, and the Part B deductible shall apply. Medicare covers different types of equipment in different ways. Depending on the kind of DME:

• You might need to rent the supplies.
• You might need to buy the supplies.
• You might be able to pick whether to rent or purchase the supplies.   

If a supplier is enrolled in Medicare but isn’t taking part, they may decide not to accept assignment. If the supplier doesn’t accept assignment, there’s no restriction on how much they can charge you.  

Talk to Your Doctor

To see how much your item, test, or service will cost, speak with your doctor or healthcare provider. How much you’ll owe may depend on many things, like:

• The type of facility
• Other insurance you may have
• The amount your doctor charges
• Whether your doctor accepts assignment
• Where you get your item, test, or service

Talk to an Agent at Trusted Senior Specialists

If you have more questions about DME or what else Medicare covers, we can help. Trusted Senior Specialists is a national insurance agency with over 15 years of experience in the Medicare market. Contact us online or call (844) 325-8710 today.