Since it was introduced back in 1965, Medicare has been providing health insurance to older and disabled people.
This federal health insurance program provides coverage to millions of Americans, with enrollment expected to reach 64 million in 2020. The program not only covers seniors aged 65 and above, but it also covers younger people with long-term disabilities and those with permanent kidney failure.
While Medicare plays a huge role in the healthcare system, its rules are complicated, and what you don’t know can hurt you. If you have enrolled in Medicare, therefore, it is important to know what is covered and what isn’t. In this article, we’ve answered a question that many Medicare beneficiaries ask, which is – what medical devices are not covered by Medicare?
Table of Contents
- 1 Medicare Part B Coverage for Medical Equipment
- 2 What’s not covered?
- 2.1 1. Equipment that’s intended for convenience or comfort
- 2.2 2. Equipment mainly intended for use outside the home
- 2.3 3. Disposable items that are not part of your home healthcare benefit
- 2.4 4. Equipment that is not suitable for use in the home
- 2.5 5. Equipment that is not primarily medical in nature
- 3 Importance of Buying DME from Medicare-approved Suppliers
Medicare Part B Coverage for Medical Equipment
There are four parts to the Medicare plan: A, B, C, and D. Each of these parts covers different parts of healthcare, with parts A and B being the most common parts that people enroll in. You can enroll in one or more parts of Medicare, depending on your income.
Out of the four parts, Medicare Part B is the part of the Medicare plan that helps to pay for Durable Medical Equipment (DME). DME is any specialized piece of medical equipment that your doctor prescribes for you to use at home on a long-term basis. For a piece of equipment to qualify as a DME, it must be medically necessary and must not be useful to someone who is not injured or sick.
What’s not covered?
Although Medicare Part B covers a wide range of durable medical equipment, not everything is covered. The following are the types of durable medical equipment that are not covered:
1. Equipment that’s intended for convenience or comfort
Medicare only covers DME that is medically necessary, not convenient. Therefore, items that are intended only to make things more convenient or comfortable are not covered by Medicare. These items include:
- Grab bars
- Stairway elevators
- Elevated toilet seats
- Shower seats
- Tub transfer benches
- Air conditioners
- Massage devices
For patients who are prone to falls, safety grab bar by the shower and the toilet are a necessity. While Medicare may pay for the bars, you may have to pay a contractor to have the bars installed.
2. Equipment mainly intended for use outside the home
Medicare Part B covers for durable medical equipment that patients can use around the house. So, if you can walk on your own for short distances within your home, Medicare will not cover for equipment that you only need outside the home, such as”
- Motorized scooter
- Motorized wheelchair
Unless you are unable to walk or operate a manual wheelchair, a motorized scooter or wheelchair would be very difficult to get approved. You can only qualify for a motorized wheelchair or scooter if you have upper extremity paralysis or weakness as a result of serious conditions, such as stroke, multiple sclerosis, etc.
3. Disposable items that are not part of your home healthcare benefit
Medicare Part B does not cover items that are thrown away after use or that are not used with DME. For instance, Medicare does not cover incontinence products, such as:
- Incontinence pads
- Under pads
Besides incontinence products, Medicare does not disposable products, such as surgical facemasks, intravenous supplies, catheters, compression leggings, disposable sheets, and gauze, etc. However, Medicare may pay for some of these items disposable items if you receive home health care. For instance, Medicare Part B may cover catheters as prosthetics if you are suffering from a permanent condition.
4. Equipment that is not suitable for use in the home
Medicare Part B does not cover for Durable Medical Equipment that is not suitable for use in the home. This includes some types of equipment used in skilled nursing facilities or hospitals, such as:
- Oscillating beds
- Paraffin bath units
- Blood glucose analyzers
- Diathermy machines
- Electrical stimulation for wounds
- Esophageal dilators
Since these types of equipment are not appropriate for use within the home, Medicare may not approve them. Therefore, you may have to purchase them out of pocket if you really need them.
5. Equipment that is not primarily medical in nature
While some types of DME may aid the recovery of a patient, they may not be covered by Medicare if they are not primarily medical in nature. Such items include:
- Humidifiers and dehumidifiers
- Exercise equipment
- Speech teaching machines
- Walk in bathtubs
- Whirlpool pumps
- Telephone arms
- Standing table
Since these types of DME are not covered by Medicare, you may have to buy or rent them out of pocket.
Importance of Buying DME from Medicare-approved Suppliers
For qualified beneficiaries, Medicare pays 80% of the cost of the covered DME. If you do not have additional insurance that covers this cost, then you are responsible for the remaining 20%. However, Medicare may not pay the 80% if you are buying the DME from a supplier that is not Medicare-approved. This is even if the equipment you need is medical in nature and is medically necessary.
To ensure that Medicare will pay 80% of the cost of the covered DME, you must ensure that you’re buying the equipment from a Medicare-approved supplier. There are two types of Medicare-approved suppliers, which are:
Medicare Participating Suppliers
These are Medicare-approved suppliers that have agreed to accept “assignment”. Assignment is the Medicare-approved price for a specific item of DME. Buying from a Medicare Participating Supplier is the most cost-effective option as it ensures that you won’t pay more than the 205 co-pay of the Medicare-approved price.
These are Medicare-approved suppliers who accept Medicare as a form of payment, but unlike Medicare Participating Suppliers, Medicare Suppliers are not obligated to accept assignment. They can freely accept assignment, but they also have the flexibility to set their own prices.
In conclusion, Medicare will not pay for any medical device if it is not medically necessary, not medical in nature, not prescribed by a Medicare-approved doctor, and not sold by a Medicare-approved supplier. If there is any medical device that you need and aren’t sure whether Medicare covers it or not, it’s best to consult with your doctor.