Medical Supplies and Equipment Covered under Medicare A - dummies

Medical Supplies and Equipment Covered under Medicare A

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What if you are on Medicare and need a wheelchair, an artificial limb, an oxygen tank, or other items that help you function but really qualify as things rather than services or treatments? Medicare has a suitably bureaucratic name for these things — durable medical equipment — and its meaning is precise.

Durable means long-lasting, and Medicare covers only items that will stick around a while. With only a few exceptions, it doesn’t cover disposable items that you use once or twice and then throw away.

To get Medicare coverage for durable medical equipment, it must be

  • Medically necessary for you, not just convenient

  • Prescribed by a doctor or another primary care professional

  • Not easily used by anyone who isn’t ill or injured

  • Reusable and likely to last for three years or more

  • Appropriate for use within the home

  • Provided by suppliers that Medicare has approved

Durable equipment that Medicare covers includes walkers and crutches; scooters and manual and powered wheelchairs; commode chairs; hospital beds; respiratory assistance devices; pacemakers; artificial limbs and eyes (prosthetics); limb, neck, and back braces (orthotics); and many more. Medicare also covers some supplies, such as diabetic test strips and lancets, but not disposable items, such as catheters and diapers.

For some items — such as oxygen equipment or seat lifts that help incapacitated people get into or out of a chair — Medicare requires a doctor to fill out and sign a Certificate of Medical Necessity; without it, Medicare will deny coverage.

In fact, to combat fraud and manage resources, Medicare is very picky about the evidence it requires for coverage — but your doctor and the supplier (not you) are responsible for providing this proof.

Medical equipment is most often rented, but some items may be purchased. In either case, Medicare Part B pays 80 percent, and you pay the remaining 20 percent (unless you have Medigap insurance that covers your share).

That’s the breakdown in traditional Medicare if you use a supplier that accepts the Medicare-approved amount as full payment. Otherwise, you pay whatever the supplier asks. If you’re in a Medicare Advantage plan, coverage is the same, but you may have different co-pays; check with your plan for details.