Before we dive into this subject, let’s set the table. Many of us live with chronic medical conditions such as high blood pressure, arthritis, diabetes, asthma, and other problems that may impact our daily activities, but do not require full time hospital care. These conditions impact our functional abilities, where certain equipment is recommended to maintain and improve one’s independence and daily life. This level of care is often called ‘custodial care’ where a family caregiver, home care agency or independent living residential care are used when the needs are great enough to require assistance (including people with dementia disorders and Alzheimer’s Disease). Credit For Caring is the best source for your products and supplies for your aging journey.
Skilled care is the opposite of custodial care. Skilled care is most often triggered by an active medical event, such as a stroke, injury, heart attack, severe viral infections, surgery, and many other life changing diseases that require acute care. Medicare pays for hospital and rehabilitation care. Most durable medical equipment recommendations and payments are in response to the new diagnosis.
What is durable medical equipment DME?
Durable Medical Equipment (or, DME) can withstand repeated use; be used to serve a medical purpose; is not useful to persons without injury or illness, and is appropriate for home use. “Durable medical equipment (DME)
Here’s What Medicare covers
- Pressure-reducing beds, mattresses, and mattress overlays used to prevent bed sores
- Blood sugar monitors
- Blood sugar (glucose) test strips
- Canes (however, Medicare doesn’t cover white canes for the blind)
- Commode chairs
- Continuous passive motion (CPM) machines
- Hospital beds
- Infusion pumps and supplies (when necessary to administer certain drugs)
- Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
- Nebulizers and some nebulizer medications (if reasonable and necessary)
- Oxygen equipment and accessories
- Patient lifts to lift you from a bed or wheelchair
- Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
- Suction pumps
How do I know when I need DME?
Great question, medical equipment must be functionally appropriate to assist the insured and the caregiver, be deemed a medical necessity to protect life, to prevent significant illness or disability or to alleviate pain, intended for medical purposes and exclusively for the insured with a confirmed diagnosis or injury and is receiving active treatment.
How do I pick the right DME for me?
If the DME is required due to a new diagnosis and level of care, then Medicare will pay for the equipment (generally with a co-pay of 20%, if under Medicare Part B). A physician prescription is required. In fact, a physician will ofter order a physical or occupational therapy consult to evaluate and select the right equipment. If the equipment is issued while in an acute care hospitalization, it is covered by Medicare Part A. Be careful, though, as equipment can be either rented or purchased. The Centers for Medicare and Medicaid set the rates that hospitals, medical supply stores, nursing homes and all other providers who get paid by Medicare must accept. However, you can purchase medical equipment on your own.
Where do I buy DME?
Today equipment can be purchased, in-person or online, at home improvement stores, specialized medical supply stores, and other online retailers, such as Credit for Caring.
Therefore, if you need DME covered by Medicare in your home, your doctor or treating provider (like a nurse practitioner, physician assistant, or clinical nurse specialist) must prescribe the type of equipment. For some equipment, Medicare may also require your doctor to provide additional information documenting your medical need for the equipment. Your supplier will work to make sure your doctor submits all required information to Medicare. If your needs and/or condition changes, your doctor must complete and submit a new, updated order. (https://www.medicare.gov/medical-equipment-suppliers/)
Is DME difficult to configure?
There is not a single answer to this question. Remember DME can be a motorized hospital bed, customized wheelchair at one extreme and, at the other, be a cane, grab bar or shower chair. DME purchased from a medical supply store accepting Medicare rates, will deliver and assemble the equipment. They will pick it up when you are finished using it as well.
Every piece of equipment from Credit for Caring comes with assembly instructions. Most manufacturers also list how to videos online as well.
What options are available to pay for DME?
Let’s stop here and distinguish between DME for skilled care and equipment for custodial care needs. Remember, anyone, at any time, can purchase equipment for their home. In fact, we recommend that home safety equipment like grab bars, toilet rails, raised toilet seats, shower chairs, canes, rollators, walkers, and other equipment be purchased in response to changing physical abilities, and to prevent falls before one occurs.
Medicare Part A pays for DME that is prescribed and issued during a hospitalization or home health care services. However, Part B is the most common coverage for DME since it covers medically necessary equipment and supplies at home or in an outpatient setting.
How do I file a claim for DME with insurance?
The Center for Medicare and Medicaid authorizes medical supply stores will file the claim for you and make certain that you meet all the criteria for coverage. In fact, I recommend always using a certified medical supply store for large items like hospital beds, Hoyer lifts, transfer lifts, customized wheelchairs, and other very expensive equipment.