Long-Term Care Planning: Durable Medical Equipment Coverage - dummies

Long-Term Care Planning: Durable Medical Equipment Coverage

By Carol Levine

Copyright © 2014 AARP. All rights reserved.

For your long-term care planning research purposes, you should know that Medicare Part B covers durable medical equipment (DME). This category of health care equipment includes devices like canes (except white canes for blind people), walkers, wheelchairs, hospital beds, commodes, and other aids that a person with a disability or a chronically ill person needs at home. (Home can be a house, an assisted-living facility, or wherever the person lives.)

A walker, for example, that you need only to take a walk down the street would not be covered.

DME can be used over and over, distinguishing these items from disposable supplies like adult diapers, bandages, and sterile gloves that can only be used once. Disposable items like these are not covered by Medicare. However, nonreusable diabetic supplies like test strips and lancets are covered, as are oxygen supplies.

In July 2013 Medicare started a National Mail-Order Program for diabetic testing supplies. You need to use a Medicare national mail-order contract supplier if you want to have these items delivered at home. You can still purchase them at your regular pharmacy or other supplier. The costs are the same and include a 20 percent coinsurance payment.

Phone or mail offers to supply DME at extremely low costs are likely to be scams. Make sure that you’re alert to these phony offers and buy only from suppliers that Medicare has approved.

DME is one of the most confusing parts of Medicare, and the rules keep changing. However, here are some points to remember:

  • Medicare only covers DME ordered by a physician.

  • The equipment has to be ordered from companies that have an agreement with original Medicare or with a Medicare Advantage plan.

  • Some areas of the country are included in Medicare’s Competitive Bidding Program, which is designed to prevent overcharging to Medicare. It applies only to original Medicare and may mean that you have to change suppliers for certain items.

  • If you are in original Medicare, you are responsible for a 20 percent coinsurance payment of the Medicare-approved amount (which may not be the full price).

  • Some items can be rented instead of purchased. There are special rules for renting oxygen equipment.

  • Medicare only pays for the basic model. If you or your parent needs a customized wheelchair or a special bed, you have to pay the extra charge.

  • Medicare covers repairs and maintenance to keep equipment in good working order, but the rules are different depending on whether you own or rent the equipment. Delays in getting DME repaired are unfortunately common.

  • If your claim for DME that a doctor has ordered is denied by Medicare’s contractor in your region (a private insurance company that reviews Medicare claims), you have the right to appeal that decision.