WHO PAYS FOR DME?
Medicare does pay for durable medical goods in some instances depending on what part of its program you are working with.
Medicare Part A (hospital insurance) – pays for durable medical items if provided during an acute care stay in hospital. In some plans it also covers DME as part of home health care, nursing home stays and hospice care.
Medicare Part B (medical insurance) – pays for durable medical equipment if deemed ‘medically necessary’. Covers the care you receive outside the hospital or nursing home stays. This pays for outpatient and therapy care, doctor’s visits, prevention care like vaccinations and DME. Here is list of the most common DME covered when prescribed by a physician as ‘medically necessary’ and within the limits of Medicare’s approved vendors:
- Blood sugar monitors
- Blood sugar test strips
- Commode chairs
- Continuous passive motion devices
- Continuous Positive Airway Pressure (CPAP) devices
- Hospital beds
- Infusion pumps and supplies
- Lancet devices and lancets
- Nebulizers and nebulizer medications
- Oxygen equipment and accessories
- Patient lifts
- Pressure-reducing support surfaces
- Suction pumps
- Traction equipment
- Wheelchairs & scooters
Medicare Part C – commonly known as Medicare Advantage. Medicare Advantage plans manage traditional Medicare benefits and may offer additional benefits under ‘supplemental’ programs. This means it covers DME like Medicare Part B and may also pay for certain DME products within specialized supplemental benefit programs. Such programs vary between MA providers.
Medicare Supplement Insurance – this is private insurance which covers items traditional Medicare does not pay for, such as co-pays and deductibles. It may also provide additional benefits which pay for DME; though, this is not consistent with all Med Supp providers.