Medicare will often cover medical supplies and equipment that are needed in your home. However, there is a certain kind of medical supplies that Medicare will not cover.

For Medicare to cover medical equipment, they need to be durable, meaning that they must be able to be used repeatedly without being damaged. Usually, this means that they have a 3-year lifetime expectancy.

That means that Medicare will not cover medical supplies that are disposable, such as gauze, bandages, and incontinence pads. There are some exceptions to this rule though. For instance, supplies needed for some medical equipment such as blood sugar test strips can be covered even though they are usually disposable.

In addition to the qualifying factors of medical supplies, other requirements need to be met for Medicare to cover them. Look below for a better understanding of what’s covered and how it’s covered.

SHOP MEDICAL SUPPLIES

 

Requirements for Medical Supplies to be Covered by Medicare

Another term that we will use to describe medical supplies that are covered by Medicare is durable medical equipment (DME). Generally, any medical supply needed for a specific piece of medical equipment is covered by Medicare as DME.

Like many of the things Medicare covers, there are requirements for coverage.

Doctors and Suppliers

The first step to making sure that Medicare will cover your DME is to make sure that the doctor prescribing the DME to you is enrolled in Medicare. Medicare does not provide coverage for medical equipment that is prescribed by doctors who are not enrolled in Medicare.

From there, you will need to make sure you receive your equipment and supplies from a DME supplier that also is enrolled in Medicare. You should also always ask your supplier if they participate in Medicare.

Participating in Medicare for a provider is different than just being willing to bill Medicare. To participate in Medicare means to accept the Medicare-approved price for the supply. If the DME supplier doesn’t participate in Medicare, they can charge you as much as 15% more than the Medicare-approved price.

Equipment Specific Requirements

Some types of medical equipment have additional requirements that must be met for Medicare to cover them. Usually, these are pieces of equipment that have a cheaper alternative. A good example of this is power scooter.

To qualify for a power scooter, you must:

  • Require the scooter in your home rather than just outside your home
  • Be able to navigate safely throughout your home with it, meaning it fits throughout your home and won’t get stuck or cause you harm
  • Have a hard time navigating your home without it due to a health condition
  • Not be able to complete activities of daily living (ADL) with a cheaper alternative such as a cane or walker
  • Be able to operate the scooter safely
  • Be able to either get on and off by yourself or always have someone there to help you

In addition to the above requirements, some states may have other rules as well.

Shop Scooters

 

What You Pay for Medical Equipment and Supplies

Medicare has parts that are designated to provide coverage for certain areas of health care. Medicare Part B oversees the coverage for outpatient services including DME and medical supplies.

Medicare Part B pays for medical equipment just like it does nearly everything else, by paying 80% of the cost after you have met the annual deductible. This means, once you have paid $185 out-of-pocket, you will begin paying 20% of the cost of your medical supplies. Don’t forget, if you don’t use a participating supplier, you could end up paying extra.

Help with Out-of-Pocket Expenses

Although 20% seems like a rather small amount, depending on your order, that 20% may end up being hundreds, maybe even thousands of dollars. Fortunately, Medigap plans can help with that.

Medigap plans help pay for the gaps in Medicare such as copays, deductibles, and coinsurance. With a Medigap plan like Plan G, all you would have to pay for is the Part B annual deductible; the rest of your DME expenses would be covered. Medigap plans allow you to use any Medicare provider but there is also another type of coverage called Medicare Advantage. These plans have networks so if you enroll in one of them, be sure to order equipment from a supplier that is in the plan’s network.

Another way you can lower out-of-pocket expenses is by renting your equipment. If you don’t need it for forever and the supplier has an option for you to rent the equipment, do that so you can save some money.

Medications Used with DME

Some pieces of equipment have the purpose of providing your body with medicine, such as an insulin pump. Normally Medicare Part D covers your prescription medications.

However, in cases like this, Medicare Part B may also oversee the coverage of the medication. This is important to know because when getting medicine for DME from pharmacies, you will want to present the correct ID card.

As long as you provide Medicare with all the documentation they ask for, you shouldn’t have a hard time buying DME and medical supplies that you need.

SHOP MEDICAL SUPPLIES