DME). This equipment is provided to Medicare beneficiaries with a doctor’s order. The list of DME includes, but is not limited to: walkers, wheelchairs, hospital beds, CPAP machines, oxygen, oxygen tubing, diabetic testing supplies and much more. DME products must be reusable. When covered by Medicare Part B your deductible applies, then Medicare pays 80% and you (or your secondary insurance) would pay 20%. If you have a Medicare Advantage plan, look at your enrollment packet information to see what your cost share would be for these items. It could be the flat co-pay, like $20 per item or a percentage, like 20%.
The larger items like hospital beds and wheelchairs, Medicare pays over a period of time, usually 13 months. Oxygen supplies are 36 month rentals. After this rental period, the equipment is yours to keep.
Medicare covers a 3-month trial of CPAP therapy if you’ve been diagnosed with obstructive sleep apnea. Medicare may cover it longer after you have seen your doctor, and documents that the CPAP therapy is helping you. The rental is for 13 months and then the CPAP equipment is yours to keep.
For DME, the general rule is if an item costs more than $150, it is usually rented. If it is under $150, it is usually purchased outright.
In order to get equipment paid for by Medicare, you must have a doctor’s order or prescription. You then take the prescription and order it from a Medicare Participating Durable Medical supplier. We have many in our area. Once there, they will help you choose a product that is right for you, fit it to your person, and if necessary, deliver it to your home (hospital bed, etc).
If you purchase this equipment outright, Medicare will not reimburse you for this expense.
Many of these items can be replaced after reaching its duration of usability. This means if you get a walker this month and Medicare or your Medicare Advantage plan helps to pay for it you may qualify for a replacement in five years. If your item needs to be replaced prior to that period, you and your physician may file a request to have it replaced sooner.
Some items cannot be purchased at the same time. For instance a wheelchair and a walker with a seat. You must evaluate which would be more useful for you at this time and get that item through Medicare. If your condition changes and requires the other item at a later date your physician may submit additional paperwork justifying your request.
Diabetic Testing Supplies also fall under the DME category. Medicare has a National Mail-Order Program for diabetes testing supplies for those individuals who order these supplies through the mail.
When looking for DME products, be sure to evaluate what you think you want before requesting paperwork from your doctor. You may want to visit a DME showroom to see all the different types of equipment available. The traditional silver walker with no wheels has been upgraded with many very useful features. Look around and decide what item suits your situation best. Then talk with your physician about getting the necessary paperwork (prescription or doctor’s order) to fill your need(s).
I am pleased you are thinking about how to prevent falls. Falls can be prevented if we take time to think about what we need, where we are going and what we are going to be doing.