Medicare pays for many home medical supplies and equipment
But you need to know the facts.
This booklet explains Medicare coverage for durable medicalequipment,prosthetic devices,orthotic items,prostheses andtherapeutic shoes in Original Medicare(sometimes calledfee-for-service) and what you might need to pay. Durablemedical equipment includes things like the following: •Home oxygen equipment •Hospital beds •Walkers •Wheelchairs This booklet also explains coverage for prosthetic equipment(like cardiac pacemakers, enteral nutrition pumps, andprosthetic lenses), orthotic items (like leg, neck, and backbraces) and prostheses (like artificial legs, arms, and eyes). It’simportant for you to know what Medicare covers and what youmay need to pay. Talk to your doctor if you think you needsome type of durable medical equipment.
“Medicare Coverage of Durable Medical Equipment and Other Devices” isn’t a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings.
What is durable medical equipment?
Durable medical equipment is reusable medical equipment such as walkers, wheelchairs, or hospital beds.
Does Medicare cover durable medical equipment?
Anyone who has Medicare Part B can get durable medical equipment as long as the equipment is medically necessary.
When does Original Medicare cover durable medical equipment?
If you have Part B, Original Medicare covers durable medical equipment when your doctor or treating practitioner (such as a nurse practitioner, physician assistant, or clinical nurse specialist)prescribes it for you to use in your home. A hospital or nursing home that is providing you with Medicare-covered care can’t qualify as your “home” in this situation. However, a long-term care facility can qualify as your home. Note: If you are in a skilled nursing facility and the facility provides you with durable medical equipment, the facility is responsible for this equipment.
What if I need durable medical equipment andI am in a Medicare Advantage Plan?
Medicare Advantage Plans(like an HMOor PPO) must cover the same items and services as Original Medicare. Your costs will depend on which plan you choose, and may be lower than Original Medicare. If you are in a Medicare Advantage Plan and you need durable medical equipment, call your plan to find outif the equipment is covered and how much you will have to pay.
What is “assignment” in Original Medicare and why is it important?
Assignment is an agreement between you (the person with Medicare),Medicare, and doctors or other health care providers, and suppliers of healthcare equipment and supplies (like durable medical equipment and prosthetic or orthotic devices). Doctors, providers, and suppliers who agree to accept assignment accept the Medicare-approved amount as full payment. After you have paid the Part B deductible ($135 in 2009), you pay the doctor or supplier the coinsurance(usually 20% of the approved amount). Medicare pays the other 80%. Suppliers who agree to accept assignment on all claims for durable medical equipmentand other devices are called “participating suppliers.” If a durable medical equipment supplier doesn’t accept assignment,there is no limit to what they can charge you.In addition, you may have to pay the entire bill(Medicare’s share as well as your coinsurance and any deductible) at the time you get the durable medical equipment. The supplier will send the bill to Medicare for you, but you will have to wait for Medicare to reimburse youlater for its share of the charge. Important Note:Before you get durable medical equipment, ask if the supplier is enrolled in Medicare. If the supplier is not enrolled in Medicare,Medicare won’t pay your claim at all. Then, ask if the supplier is a participating supplier in the Medicare Program. A participating supplier must accept assignment. A supplier that is enrolled in Medicare, but isn’t “participating,” has the option whether to accept assignment. You will have to ask if the supplier will accept assignment for your claim.
Below are links to the Medicare Website: