What kind of durable medical equipment (DME) does Medicare cover?

 

 

 

 

 

 

 

 

 

 

 

What kind of DME does Medicare not cover?

• Equipment to mainly help you outside the home
• Items intended only to make things more convenient or comfortable
• Items that you throw away after one use
• Items that you don’t use with equipment
• Modifications to your home
• Equipment not for use in the home

For example: Air conditioners, incontinence pads, surgical facemasks, oscillating beds

Note: Some Medicare Advantage Plans may cover minor home modifications or other items as a supplemental benefit.

 

How does Medicare cover my DME?

Your primary care provider (PCP) must prescribe your DME. Your PCP must sign an order, prescription, or certificate. In this document, your PCP must state that:

• You need the DME to help a medical condition or injury.
• The equipment is for home use.
• And, if applicable, you had a face-to-face visit with your PCP. Your PCP should know if Medicare requires this visit for your DME.

If you need a manual or power wheelchair or scooter, the process is different. Speak with your doctor for more information.

 

What supplier should I use to get my DME?

 Once you have your PCP’s order or prescription, you must take it to the right supplier.

 

If you have a Medicare Advantage Plan:

• Follow your plan’s rules for getting DME. For example, you may have to:
  • Get approval from the plan before getting your DME
  • Use a supplier in the plan’s network of suppliers
  • Use a preferred brand of DME

 

If you have Original Medicare:

• Get your DME from a Medicare-approved supplier that takes assignment.
  • Suppliers who take assignment can’t charge you more than 20% of Medicare’s approved amount for the cost of the DME.
  • Many suppliers are Medicare-approved but don’t take assignment. These suppliers can charge you more than 20%. Medicare will still only pay 80% of its approved amount for the DME, so you’ll have to pay any extra costs.
• Don’t use suppliers who haven’t signed up to bill Medicare for DME.

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