Durable Medical Equipment Provider for Security Blue Hmo
What Is Durable Medical Equipment and Where Can I Buy It?
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When you're trying to navigate aging in place or managing an illness or disability, it can be hard to keep up with all of the lingo. To help, we're going to explore a popular term that you're likely to encounter as you age: durable medical equipment (DME).
DME might sound straightforward since you already know what each word means, but it's actually a specific term used by Medicare, Medicaid, and other insurance companies. In general, durable medical equipment is medically necessary supplies and devices that you can use over and over again.
Seniors, who are more likely to have a chronic illness or mobility difficulties, need durable medical equipment more than other age groups.1 That's why we're going to cover DME items, insurance coverage for durable medical equipment, and more below.
What Is Considered Durable Medical Equipment?
Durable medical equipment includes medical devices and supplies that can be used again and again, such as a hospital bed in your home or a prosthetic limb. The opposite of DME would be single-use medical equipment like bandages or incontinence pads.
It's important to understand what counts as DME and what doesn't, because that affects insurance coverage. Most government and private health insurance plans will cover all or some of the expenses associated with durable medical equipment.
To qualify as DME, the item must:2
- Primarily serve a medical purpose
- Be prescribed by or ordered by a medical provider
- Be able to be used again and again
- Generally have an expected lifetime of at least three years
- Be used in the home
- Only be useful to patients who have an injury or disability
The most common examples of durable medical equipment used outside of a hospital include:
- Kidney machines
- Traction equipment
- Orthotics
- Prostheses
- Oxygen concentrators, monitors, ventilators, and related supplies
- Personal care aids like bath chairs, dressing aids, and commodes
- Mobility aids such as walkers, canes, crutches, wheelchairs, and scooters
- Bed equipment like hospital beds, pressure mattresses, bili lights and blankets, and lift beds
Are Hearing Aids Durable Medical Equipment?
When you read over the criteria for durable medical equipment, it sure seems like hearing aids should count. After all, you wear them every day, and they last longer than three years. Unfortunately, they aren't considered DME.
Nearly 25 percent of those aged 65 to 75 and 50 percent of those 75 and over experience hearing loss, but hearing aids still aren't classified as durable medical equipment or covered by Medicare and most private insurance companies.3
Instead, hearing aids are classified as elective or Class I medical devices.4 Class I medical devices, by definition, aren't medically necessary. Since DME only includes medically necessary items, hearing aids don't qualify. If you're worried about the cost of hearing aids since they're not classified as Medicare-approved DME, watch the video below. Audiologist Brad Ingrao covers the best ways to find free or reduced-cost hearing aids.
Durable Medical Equipment vs. Adaptive Equipment
As you saw above, durable medical equipment includes reusable devices and supplies that serve a medical purpose. Adaptive equipment is another category of equipment that helps seniors and those with short- or long-term disabilities, but it doesn't have to serve a medical purpose.
The category of adaptive equipment includes devices and supplies that assist with mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs).5 That means items that help make dressing, bathing, toileting, eating, communication, entertainment, and mobility easier, safer, or more accessible. The chart below outlines examples of adaptive equipment so you can differentiate them from DME.
Common Adaptive Equipment
| For ADLS | For IADLS | For Mobility |
|---|---|---|
|
|
|
For the most part, adaptive equipment is not considered medically necessary, so it is not durable medical equipment nor covered by insurance. However, there are a few exceptions. For example, Medicare labels commodes, canes, scooters, and wheelchairs as durable medical equipment in certain situations.
What Durable Medical Equipment Is Covered by Medicare?
On Medicare? You may be in luck if you need durable medical equipment. Medicare Part B covers DME as long as your medical provider prescribes it for home use.
DME covered by Medicare includes (but isn't limited to):6
- Mobility aids: walkers, wheelchairs, scooters, crutches, canes, and patient lifts
- Diabetes supplies: blood sugar meters, blood sugar test strips, lancets, and lancing devices
- Breathing equipment: nebulizers, nebulizer medications, oxygen equipment and accessories, and CPAP devices
- Continuous passive motion devices
- Commode chairs
- Hospital beds
- Pressure-reducing support surfaces
- Infusion pumps and supplies
- Suction pumps
- Traction equipment
Types of DME not covered by Medicare include:7
- Equipment whose primary purpose is to help you outside of the home
- Items designed to improve your comfort or add convenience, like grab bars, air conditioners, or toilet seats
- Single-use items like incontinence pads or surgical face masks
- Home modifications such as widened doors or ramps
- Items purchased from a supplier or business that does not accept Medicare payments
How Much Does Medicare Cover for Durable Medical Equipment?
Under Original Medicare, Medicare covers 80 percent of the cost, so you need to pay 20 percent of the Medicare-approved amount. The Part B deductible also applies. Just make sure that the doctor prescribing the equipment and the supplier are both enrolled in Medicare. If not, Medicare won't pay the claims.
Medicare also covers DME in different ways. Depending on what equipment you need, Medicare might say that you need to rent the equipment, that you need to buy the equipment, or that you can choose whether to rent or to buy the equipment.
How to Find Medicare-Approved Durable Medical Equipment Suppliers Near Me
The easiest way to find local Medicare-approved DME suppliers is to use Medicare's official Find Medical Equipment and Suppliers search tool. You can use the tool in two different ways.
- Method 1: Type in your ZIP code and a supplier's name to check if they participate in Medicare.
- Method 2: Type in your ZIP code and the name of the equipment that you need to find a local supplier.
You can also contact Medicare directly with any questions about equipment coverage or finding a supplier:
- Online: Log in to your secure Medicare account
- Phone: 1-800-MEDICARE (1-800-633-4227)
- TTY: 1-877-486-2048
Once you find a supplier, remember to ask about costs and coverage to ensure that you pay as little as possible out of pocket.
Does Medicaid Cover Durable Medical Equipment?
Medicaid programs vary from state to state, which means that what Medicaid covers also varies by state. To find the most relevant information, we recommend calling your state's Medicaid office or visiting their website.
In general, Medicaid will cover medical equipment that's medically necessary and cost-effective, and that meets the state's definition of durable medical equipment. That definition varies, but it's often similar to the one that Medicare uses. Many state Medicaid programs cover 100 percent of the cost of any home medical equipment you need.
Receiving Medicaid coverage for durable medical equipment typically looks like this:
- You get a medical justification letter from your medical provider that outlines why you need the item.
- You choose a Medicaid-approved supplier and give them the letter.
- The supplier fills out a prior approval (PA) application and sends it to the state Medicaid office.
- The state Medicaid office either approves or denies the claim.
- If it's approved, the supplier sends you the DME and sends the bill to Medicaid.
- If it's denied, you will receive a letter outlining why, with the option to appeal.
Again, the process will vary depending on where you live. We just wanted to give you an idea of what to expect.
Other Ways to Pay for Durable Medical Equipment
Sometimes Medicare or Medicaid won't pay for the item you need, or maybe you just don't want to wait to find out if what you need will be approved. In either case, here are a few other ways that you can pay for durable medical equipment:
- Private insurance: Private insurers typically cover durable medical equipment. Speak directly with your private insurer to find out details about coverage.
- Veterans health care: Veterans and their spouses can turn to the Department of Veterans Affairs for help with a Medicare copayment for DME or with the entire cost of DME. The VA has several programs available, such as CHAMPVA benefits and Tricare.
- Private pay: Paying out of pocket is always an option, even if you have insurance. You might even find that it's the quickest way to get the equipment you need. Just make sure you understand the cost difference if you choose to pay for something privately that Medicaid, Medicare, or another insurance policy would cover. Buying DME secondhand often halves the cost, so check eBay or Facebook Marketplace, classified ads, and thrift stores like Goodwill.
- Nonprofit or state assistance: Some nonprofits, national foundations, and states help seniors pay for durable medical equipment through grants, low-interest loans, assistive technology programs, and financial aid programs. Visit your state's website or call your local Area Agency on Aging office for assistance in locating available programs.
Source: https://www.seniorliving.org/durable-medical-equipment/
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