If you or a loved one are in need of durable medical equipment to help with a disability or injury, then you might be curious about how much Medicare will cover. Luckily, Medicare has clearly defined its coverage limits and rules, meaning that with a little research, you’ll be able to get a better idea of what you’ll need to pay out of pocket.
Understanding the Different Parts of Medicare
While there are four different levels of Medicare, only three are particularly relevant when it comes to durable medical equipment: Part A, Part B, and Part C. Generally Part A covers hospital or other inpatient care, Part B covers outpatient care, and Part C is a combination of the both that’s managed by private insurance companies. The good news is that all of these parts do offer coverage for durable medical equipment, just with different requirements.
Rules for Durable Medical Equipment Coverage
In all cases, durable medical equipment must be purchased from an approved seller and must be deemed medically necessary by a doctor or other treating medical practitioner. However, each level of coverage does have slightly different rules you’ll need to follow to get reimbursed.
Because Part A covers hospitalized care, all patients who need durable medical equipment must be homebound and require skilled nursing care.
As most patients do not meet the strict qualifications for Part A coverage, Part B is the more common choice when seeking Medicare reimbursement for equipment. You do not have to be homebound, but the device will need to be for use in a personal care home or your own home. Additionally, the item in question must be:
- Designed for use in your home (but it can be used out of the home as well)
- Designed to assist with your specific injury or disorder
- Designed to last for a minimum of three years
As Part C is a combination of Part A and Part B, coverage here can fall under either of these categories.
Types of Durable Medical Equipment That Medicare Covers
Luckily, the list of durable medical equipment that Medicare provides coverage for is quite large. In general, devices that assist with mobility, breathing, and self-care are usually on the list. Some of the most popular items include:
- Walkers, crutches, canes, and scooters
- Hospital beds
- Seat lifts
- Oxygen equipment
- Blood sugar monitors and testing strips
- Commode chairs
- Infusion pumps
- Sleep apnea devices
- Suction pumps
- Traction equipment
If the item you’re thinking about isn’t on the list, it’s always best to check directly with Medicare before purchasing it just to make sure you’ll be able to be reimbursed.
What You’ll Need to Pay
In most cases, Medicare will cover 80 percent of the bill for approved durable medical equipment. This means you will have to pay 20 percent of the Medicare-approved amount as well as your usual deductible. Because some equipment is much more expensive than others, Medicare requires that you:
- Rent equipment instead of buying it
- Buy equipment instead of renting it
- Decide on your own whether to rent or buy it
Before choosing a supplier, it’s important to make sure that they have an assignment agreement between Medicare, your doctor, and you. With assignment, your doctor or supplier will be willing to accept the Medicare-approved amount as a full payment even if it’s not what they usually charge.
If a supplier doesn’t accept assignment for durable medical equipment, they can charge you whatever they like, meaning that you’ll pay more than the standard 20 percent. Even worse, if you choose a supplier that isn’t enrolled in Medicare, then Medicare won’t cover anything.
Where to Find Approved Suppliers
Luckily, Medicare does maintain a list of approved suppliers who sell equipment that is covered. However, instead of spending hours searching, why not simply choose one of the most trusted suppliers in all of Florida? Comfort N Mobility offers a number of products to help seniors regain their mobility again, including power wheelchairs, rehab chairs, and more. Contact us today at 850-934-5217 to learn more about how we can help.