Senior Medical Supplies and Equipment - DME

by L. E. Green author of The Nursing Home Survival Guide

Seniors who aren’t located in nursing homes often require supplies and equipment to allow them to remain independent.  Depending upon their insurance plan, there may be coverage for all or some of these items.  Medicare Part B covers durable medical equipment (DME) and medical supplies at 80%, although it’s possible that a Medicare Supplement (Medigap plan) will cover some or all of the additional 20%.  In order to obtain these items, a doctor must order them for the senior and they must be deemed medically necessary for the senior to maintain his independence.  

Durable medical equipment includes:

  • Hospital beds and air mattresses
  • Blood glucose monitors
  • Crutches
  • Canes
  • Wheelchairs
  • Front-wheel walkers
  • Four-wheel walkers
  • Bedside commodes
  • Home oxygen equipment and supplies
  • Nebulizers and most treatments
  • Ventilators
  • Suctioning Pumps
  • Wound Vac’s and supplies
  • Hospital beds
  • Infusion pumps and some medicines used in them
  • Lymphedema pumps
  • Patient lifts
  • Traction equipment
  • Transcutaneous electronic nerve stimulators (TENS) units
  • Prosthesis, including diabetic shoes  

Covered medical supplies include:

  • Pumps and supplies for feeding tubes
  • IV pumps and supplies
  • Arm braces, leg braces, neck & back braces
  • Splints and casts
  • Ostomy bags
  • Surgical dressings
  • Diabetic supplies, including glucose monitors, test strips, and lancets.  

Medicare will only cover the items if they’re obtained from a medical equipment company that is a contracted provider – there is no mechanism for the items to be purchased from a big box store or from a private party.  That’s unfortunate, because the program could save millions of dollars on the items if they were to expand their provider base.  It’s possible to find wheelchairs and other equipment for sale in thrift stores and at garage sales for substantially less than the copayment Medicare requires.

For seniors who require the equipment on a temporary basis, Medicare will pay the rental cost.  However, if it becomes cheaper for Medicare to purchase the items outright, Medicare buys the item for the senior.  This is true for most equipment except for oxygen concentrators – Medicare pays a rental amount to the equipment company for 3 years, after which the company is required to support the customer for an additional two years for free.  

After five years, the senior is able to obtain new equipment from that, or another company and Medicare will again cover the first 3 years.  

You have the right to choose which DME company will provide the equipment that you require (unless you have a Part C Advantage plan, which limits your choice).  There are both national and local DME companies; neither provides a better service.  If a senior travels, it might be beneficial to use the services of a national corporation for his oxygen and equipment needs.  Any DME company can provide information about air travel, and can either assist with the equipment the senior needs or refer him to a company that can provide the support.  

Medicare also provides motorized wheelchairs and scooters for seniors who have difficulty propelling a wheelchair.  In order to qualify for these items it’s necessary for the equipment company to obtain both a doctor’s order and a physical therapy evaluation.  The full cost of these items start at $5,000, so the co-payments are quite high.  There are companies that advertise they’ll provide a scooter for free even if Medicare doesn’t pay them; if you read the “fine print” you’ll see that their guarantee says that if they’ve delivered the chair and the payment is denied, they won’t charge the customer.  Sometimes they don’t deliver the chair until the payment has been approved, or they won’t deliver it at all due to insurance denials.  It’s a rare occasion when they’re not paid for the equipment that they provide.  

Most SNF’s (skilled nursing facilities) whose room & board is paid by Medicaid won’t pay for motorized chairs. As these facilities are required to provide all of the equipment that their patients need regardless of the cost, they typically opt for cheaper manual wheelchairs.  Residents who are unable to operate manual wheelchairs are often at the mercy of the staff to get around.  Some states provide motorized wheelchairs for Medicaid residents of SNF’s who aren’t able to manually operate wheelchairs, but most do not; any local medical equipment company can let you know what’s covered.

The Medicare program requires that Advantage plan providers provide payment for the same items as Traditional Medicare, although the out-of-pocket costs might be a different amount.  Seniors who are dual eligible (eligible for both Medicare and Medicaid) may have additional benefits depending upon the state in which they live.  If you have any questions about what might be covered, call a local DME provider or home healthcare company.  They not only can provide you with the information you need, but can also help with obtaining the necessary authorizations.  Additional information about DME can be found at http://www.medicare.gov/Publications/Pubs/pdf/11045.pdf