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Durable Medical Equipment. What is it and how do I get it if I need it?

Durable Medical Equipment (DME) covers Medicare approved in-home medically necessary items that your Doctor prescribes. In order for an item to be covered, it must be ordered by your Doctor for use in the home and is;

-Durable (long lasting)

-Used for a medical reason

-Used in your home

-Not useful to someone who isn’t sick and/or injured.

A list of covered DME items can be, but not limited to; *

Air-fluidized beds and other support surfaces

Blood sugar monitors

Blood sugar (glucose) test strips

Canes (however, white canes for the blind aren’t covered)

Commode chairs

Continuous passive motion (CPM) machine

Crutches

Hospital beds

Infusion pumps and supplies (when necessary to administer certain drugs)

Manual wheelchairs and power mobility devices

Nebulizers and nebulizer medications

Oxygen equipment and accessories

Patient lifts

Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories

Suction pumps

Traction equipment

Walkers

The way you procure durable medical equipment differs based on how you are insured.

Medicare Advantage:

If you have replaced your Medicare parts A, B and D with an “All-in-One” Medicare advantage plan, then you would simply use your provider directory to select a provider. The co-insurance costs associated would be outlined in your plan, but average 20% of the negotiated cost of the DME. (Stop here!)

Medicare Parts A & B and a Medicare Supplement (Medigap):

Any person who’s enrolled in Part “B” of Medicare is eligible for DME coverage.

Your Doctor and Supplier must be enrolled in Medicare; otherwise Medicare will not cover any of the cost. The Suppliers must be “participating in Medicare” in order to have Medicare pay part or all of the cost associated with the DME.  If the supplier is enrolled but “Non-participating in Medicare”, they will accept Medicare’s payment but pass on any additional fee or cost balance not covered by Medicare to your Medicare supplement plan.  If you have a Medicare Supplement Plan F, you will have no co-pay or cost associated with any covered DME.   (Stop here!)

Medicare Parts A & B only:

Any person who’s enrolled in Part “B” of Medicare is eligible for DME coverage.

You may also live in a Medicare “Competitive Bid Area” geographically. The Metro Phoenix area as well as Tucson Metro is included in geographic

Competitive Bid Areas. This means there are certain suppliers in your area that you must purchase your DME items from in order to qualify for the Medicare co-pay. Or your supplier must agree to the Medicare assignment of cost.

On most items there will be 20% co-pay after the Medicare Part “B” deductible that is currently $166.00. You only pay this deductible once during a calendar year, then in addition, any co-pays that are required. Your Doctor and Supplier must be enrolled in Medicare; otherwise Medicare will not cover any of the cost.

The Suppliers must be “participating in Medicare” in order to have Medicare pay part or all of the cost associated with the DME. If the supplier is enrolled but “Non-participating in Medicare”, they will accept Medicare’s payment but pass on any additional fee or cost balance not covered by Medicare to you, the consumer.

You can check at “Where to get DME covered items” or go to www.Medicare.gov and select the tab at the top right of the page that states “Forms, Help, and Resources. The drop down menu will offer several instructional pages.

List obtained from www.Medicare.gov

(Previous published in the February 2016 Edition of the American Retirement Advisor Newsletter)