Home Medical Equipment

What is durable medical equipment? How do you pay for it? How are you supposed to know what your loved one needs? Here are the basics.

What Is Durable Medical Equipment?

Generally, Medicare defines durable medical equipment as equipment that:

  • Is prescribed or ordered by a doctor.
  • Is medically necessary.
  • Is appropriate for use in the home.
  • Fills a medical need. (That is, it has to be more than a convenience.)
  • Is “durable,” meaning reusable. (This requirement would not apply to medical supplies.)
  • Is not the kind of equipment used by people who aren’t sick or injured.

Caregivers often discover too late that certain types of durable medical equipment are covered by insurance. If a doctor certifies that your loved one requires a temporary hospital bed or wheel chair, for instance, the cost of the equipment may be a covered expense.

What Isn’t Covered By Medicare?

In general, Medicare doesn’t cover equipment that fails to meet the above requirements, even if the equipment is useful or even necessary. For example, bathroom grab bars aren’t covered because they aren’t primarily medical in nature; a new air conditioner isn’t covered because an air conditioner doesn’t serve a primarily medical purpose; elevators and other lift devices aren’t covered because people who aren’t sick or injured still use them.

What Is Covered By Medicare?

Medicare Part B helps pay for medical equipment and supplies used in the home, such as oxygen equipment, wheelchairs, artificial limbs, braces, and hospital beds. If your loved one is insured by Medicare, his or her Medicare Handbook will contain more information about what is and isn’t covered.

Finding Durable Medical Equipment

If a doctor decides that your loved one requires home medical equipment, the doctor can work with a supplier to find the most appropriate items. The doctor should know your loved one’s overall health condition, his or her specific medical needs, his or her living situation, and how long he or she will need the particular equipment. Your loved one’s doctor also is responsible for providing a complete medical prescription to the equipment supplier.

If your loved one is about to be discharged from a hospital, a discharge planner will follow the attending physician’s instructions about your loved one’s need for particular equipment, and the planner may also refer you to one or more equipment suppliers. The discharge planner usually will contact the supplier you choose, and the supplier will then contact your loved one’s physician to obtain all the necessary medical information. Afterwards, the supplier will make arrangements to deliver, set up, and demonstrate the equipment.

During this time, it’s important to be aware of Medicare and medical equipment fraud. You should be suspicious of door-to-door equipment salesmen, or suppliers who contact you or your loved one before a discharge planner or doctor talks to you. Suppliers have no way of knowing your loved one’s exact medical needs, and a responsible supplier cannot make recommendations until he or she knows your loved one’s complete medical situation.

A Reputable And Reliable Supplier:

  • Has roots and a reputable business standing in the community. The business should not have numerous complaints filed with Better Business Bureaus or State Consumer Protection agencies.
  • Delivers the equipment, sets it up, and makes sure you or your loved one understands how it works. If the equipment is potentially hazardous, the supplier should explain the dangers involved.
  • Is responsive to inquiries or complaints about the equipment or its use. The supplier should ensure the equipment is performing up to requirements and that you and your loved one aren’t having problems.
  • Honors all warranties expressed or implied under state law.
  • Refers you or your loved one to the appropriate Medicare carrier if you have questions about Medicare.
  • Provides or arranges for service and maintenance to the equipment and has a 24-hour emergency service number.
  • Provides equipment that is clean and in good working condition when delivered. If the equipment is supposed to be new, it should not show wear or prior use.
  • Lets you return equipment that is substandard or unsuitable for use.
  • Does not offer to waive Medicare co-payments or deductibles, without first determining financial hardship. (See your loved one’s Medicare Handbook for more information.)
  • Tells you about supplier standards to which it must conform.
  • Is a member of local or national trade associations or organizations.

What is durable medical equipment? How do you pay for it? How are you supposed to know what your loved one needs? Here are the basics.

Paying For Durable Medical Equipment

Medicare pays for durable medical equipment in different ways, depending on the item or service (including service calls for repair and maintenance) and whether you buy or rent the equipment.

If your loved one has met his or her deductible for the year, Medicare pays 80 percent of the Medicare-approved cost of durable medical equipment—regardless of whether or not the supplier “takes assignment.” Assignment means that the supplier agrees to accept the Medicare-approved amount as payment in full. If your loved one obtains equipment from a supplier who does not take assignment, then your loved one is responsible for the difference between what Medicare pays and what the supplier charges. If the supplier does take assignment, your loved one is responsible for the 20 percent of the cost that Medicare doesn’t cover.

To keep your loved one’s costs to a minimum, find out beforehand whether the supplier accepts Medicare assignment. In addition, all medical equipment suppliers are required by law to “do the paperwork” and bill Medicare, regardless of whether or not they take assignment.

After your loved one has met his or her deductible, he or she is still responsible for paying at least 20 percent of the Medicare-approved amount for durable medical equipment. This co-payment may not be dropped by the supplier except in very special hardship situations and only on a case-by-case basis. A supplier who routinely drops the co-payment may be violating federal law.

You Can Buy Or Rent Medical Equipment

  • Your loved one can rent equipment for up to 15 months.
  • Medicare pays rental for no more than 15 months. (The supplier will still rent the equipment for as long as your loved one needs it, but Medicare doesn’t pick up the cost.)
  • Suppliers who have received 10 months of rental payments from Medicare must offer your loved one the option to buy the equipment. If he or she decides to purchase the item, the supplier must transfer title for the item following the 13th rental month. The decision to buy the equipment changes the rental payments to installment payments.
  • Remember, if your loved one decides to continue renting the equipment, Medicare will stop paying for the equipment following the 15th month, except for service and maintenance.

© Copyright FamilyCare America, Inc. All Rights Reserved.

Adapted from Medicare and Home Medical Equipment developed by the United States Department of Health and Human Services. Health Care Financing Administration.

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