Medicare DME and Medicare Coverage
Medicare DME, (DME) is the acronym for durable medical equipment. DME is reusable medical equipment such as hospital beds, wheelchairs, walkers and the like. In traditional or original Medicare it is part B that provides coverage for DME. Medicare Advantage Plans are required to cover at the minimum what original Medicare covers and may even cover more of the cost. The best way to find out exactly what the plan covers is to call them directly and ask.
Medicare DME that Qualifies for Coverage
The DME that qualifies for Medicare part B coverage must be medically necessary, must be prescribed by your medical practitioner for use in home.
A partial list of DME that qualifies would be:
blood glucose monitors
home oxygen equipment and supplies
oxygen and related equipment
wheelchairs including power
The Importance of Medicare Assignment and the DME Supplier
Medicare assignment is an agreement between the Medicare recipient, Medicare, the healthcare providers and/or the supplier of healthcare equipment or supplies. The healthcare providers or suppliers agree to the Medicare-approved amount as payment in full for said services. Suppliers for durable medical equipment DME who agree to accept Medicare assignment are called "participating suppliers". Suppliers who are not Medicare participating suppliers can charge unlimited amounts for their products or services as they are not regulated or governed by Medicare.
The supplier must be enrolled in Medicare or Medicare will not pay the claim at all. And "enrolled Medicare supplier" has the option of whether to accept assignment or not, so smartly ask them whether they accept assignment before purchasing.
Participating Medicare suppliers will accept Medicare assignment – Medicare enrolled suppliers have the option of Medicare assignment – all other suppliers Medicare will not pay the claim at all.
Medicare DME is Purchased or Rented
The discretion of whether Medicare DME is bought or rented is that of Medicare. The DME participating or enrolled supplier will know whether it's rented or owned equipment. Either way Medicare covers the approved DME by purchase or rental payment. Typically the low-end equipment such as canes would be purchased and bigger ticket items like powered scooters would be a rental. Medicare provides coverage for repairs and/or replacement of approved DME due to normal wear and tear from patient use.
Medicare DME Coverage
Medicare part B will cover 80% of the approved assignment cost of DME purchase or rental. This leaves the Medicare recipient responsible for the other 20% plus any Medicare part B annual deductable owed.
Medicare Coverage Homework
In considering Medicare coverage options, there are a lot of different elements to consider. To make smart Medicare choices, do not approach the project lackadaisically. Research to understanding and really weigh options.
Health needs to be one of the first and foremost considerations. Be sure to have adequate care to ensure good health for as long as possible. Preserving good health with more choices is smart regardless. Being aware of personal health needs (current and anticipated) will help in steering toward the best plans.
Budget is an utmost consideration. In looking at the different ways to access Medicare—through the government and through approved private providers—there are definitely cost differences. However, in looking at monthly costs, also consider the price of personal time. A little convenience may save enough personal time to justify a cost difference between plan providers.
Budget concerns should include accurately tallying up prescription and yearly discretionary health costs. The size of these numbers should indicate whether or not Part D coverage for prescription drugs would be a good financial move.
Finally, do not forget that there are also supplemental plans available. Commonly referred to as Medigap or Medicare Supplement Insurance, these plans help fill in gaps in the Medicare Part A and Part B coverage. Medicare supplement insurance will provide more complete coverage, lower financial risk and out-of-pocket medical expenses for the price of the premium. Again, do the homework, research and compare plans The Medicare and You Handbook contains important information about what's new in health plans, prescription drug plans, and recipients rights and protections. It helps people with Medicare review their coverage options and prepare to enroll in a new plan if they choose.
The official Medicare DME guide or Booklet is an excellent resource for anyone interested in Medicare DME providing considerable in-depth detail along with support 800 call numbers.
Other Medicare Coverage Resources You May Find Helpful
State-by-State Medicare Locator
A Guide for Families and Friends of People with Medicare
2013 & 2014 Medicare Costs At A Glance
Locate a Geriatric Specialist by Insurance
Assisted Living Locater and Resource