I can very much sympathize with anyone who has allergies, having been plagued with allergies to all kinds of pollen, dust mites, tree bark molds and asthma for over 45 yrs. If you are a caregiver to an elderly loved one who also has these problems, you may be wondering about whether Medicare will help with an air purifier.
Medicare does not cover air purifiers for use in the home, as they are considered to be “environmental control equipment” and “not primarily medical in nature”.
Contents Overview & Quicklinks
What are air purifiers ?
Air purifiers are machines which filter particles from the air, such as –
- mold spores
- dust mite feces
- smoke particles
All of these can be an irritant to someone with allergies or a respiratory condition.
There are two basic types of air purifiers –
- passive or filtration air purifiers
- active or electrostatic air purifiers
Passive or filtration
The air purifiers, which work “passively” by passing the air through filters which remove the particles from the air by entrapping them in filters.
HEPA filters are a well known type of passive Air purifying system which can filter out 99.7 % of 0.3 micron particles – tiny stuff.
Active or electrostatic
This type of air purifier charges the air with negative ions, which causes particles in the air to stick to surfaces.
Ionizer air purifiers are the popular term for this type.
Why does Original Medicare Part B reject air purifiers for coverage ?
For any equipment to be covered by Original Medicare Part B, it must fall into the category of Durable Medical Equipment or DME.
Medicare does not classify air purifiers as DME because it considers them to be “environmental control equipment” and “not primarily medical in nature“.
The same applies for air conditioners, dehumidifiers, room heaters and humidifiers for room heating – they are all denied coverage on the grounds that they are for “environmental control”.
You can take a look at the guidelines on the Centers for Medicare and Medicaid Services website – CMS.gov – where you will find the “National Coverage Determination (NCD) for Durable Medical Equipment Reference List (280.1)”, and you can click here to see it.
You can just go down the list of equipment and see what is, and isn’t, accepted for coverage, along with the reason why.
This may not be the case with Medicare Advantage plans, as the benefits they are permitted to offer, are being broadened. Advantage plans may be allowed to offer benefits for equipment which will either, help to improve, or maintain the state of health of individuals with a chronic condition. Benefits covering air conditioners and air purifiers may be offered by some Advantage plans.
Does Medicare cover humidifiers ?
Humidifiers are sometimes covered by Original Medicare Part B if they are being used in conjunction with covered durable medical equipment for a medical need –
“Medicare covers humidifiers when there’s a medical need to use them with certain covered durable medical equipment (DME), like continuous positive airway pressure (CPAP) devices, respiratory assist devices, or oxygen equipment. “
Source: Medicare.gov – you can see the whole text on the Medicare site if you click here.
But, as I said before, they are not covered if you are just trying to make a room less dry.
Does Medicare cover bathroom equipment ?
What has become clear to me, during my time researching all the articles on Medicare coverage, is that equipment that has a role in safety, and in preventing accidents, which I thought would get coverage from Medicare, does not.
And alas, bathroom safety equipment is a big loser in all of this.
Because everything which is covered by Medicare must be “medically necessary”, a large percentage of equipment which works to help the elderly maintain their independence in their homes, creating a safe environment for them, is not going to be covered by Medicare.
None of the following items for bathroom safety are covered by Original Medicare Part B –
- grab bars
- raised toilet seats
- bath lifts
- floor to ceiling poles
- shower chairs
- bath chairs
- toilet safety frames
Happily, Original Medicare Part B does give coverage to certain equipment for those with serious mobility issues, as it is “medically necessary”, because without it many basic tasks are impossible.
For those with serious mobility issues, the following equipment is covered and can be used in the bathroom to make it a safer place –
- bedside commodes
Bedside commodes can be used as a raised toilet seat, a shower chair (if they are waterproof), and also as a safety frame for the toilet.
Walkers, which are waterproof, can be used in the shower as an aid to standing.
Now if you have a Medicare Advantage Plan, or Medicare Part C as it is also known, you may already have your bathroom safety equipment covered, if you are suffering from a chronic illness.
In the fall of 2020 the first Medicare Advantage Plans were permitted to offer new benefits for individuals with chronic illnesses, and among the benefits was possible coverage for some items of bathroom safety equipment. Whether you get a benefit for bathroom equipment will simply depend on if your Advantage Plan is offering it, and if you qualify.
What equipment does Medicare cover ?
Typically, Original Medicare Part B covers 80% of the Medicare-approved cost of equipment for use in the home that is “durable medical equipment” or DME.
There is a long list of Durable Medical Equipment covered by Medicare, which you can jump down to see here.
For Original Medicare is going to consider equipment to be Durable Medical Equipment, it needs to meet the following criteria :-
- Durable (can withstand repeated use)
- Used for a medical reason
- Not usually useful to someone who isn’t sick or injured
- Used in your home
- Generally has an expected lifetime of at least 3 years
Source: Medicare.gov website – read it here.
Typical examples of equipment which Original Medicare covers are items such as wheelchairs, crutches and walkers, which are seen as “medically necessary”.
Comfort or convenience items are not covered by Original Medicare, such as shower chairs, air purifiers or wigs.
Original Medicare Part B’s coverage typically extends to 80 % of the Medicare-approved cost of the durable medical equipment and the beneficiary will be responsible for their coinsurance payment of 20% of the Medicare-approved cost, and also, if it applies, their annual policy deductible.
Does Medicare cover ice machines ?
Original Medicare Part B partially covers certain cold and heat therapies on an inpatient, or outpatient basis, when prescribed as “medically necessary” by a Medicare enrolled physician, or by a therapist and co-signed by a physician.
Unfortunately, though, this does not extend to ice packs and cooling therapy items which Medicare considers not to be “reasonable and necessary”.
This means that “ice machines” do not fall into the category of Durable Medical Equipment.
The following passage is from Blue Cross Blue Shield of Rhode Island – they must follow the Original Medicare guidelines when providing Medicare services.
“Cooling Devices used in the Home and Outpatient Setting”
Medicare “not reasonable and necessary:” Medicare indicates cooling therapy items do not fit the definition of reasonable and necessary and are therefore not be covered. Medicare defines services/items “not reasonable and necessary” as items not “reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”
Services denied as not reasonable and medically necessary, under section 1862(a)(1) of the Social Security Act, are subject to the Limitation of Liability (Advance Beneficiary Notice) provision. Thus, to be held liable for denied charge(s), the beneficiary must be given appropriate written advance notice of the likelihood of non-coverage and agree to pay for services.
You can find the source document here.
Here is another text on cooling devices from-
Premera, Blue Cross – Cooling Devices Used in Outpatient Setting – May 2019
Medicare National Coverage
While there is no national coverage decision for Medicare, cooling devices are addressed in Durable Medical Equipment Resource Center (DMERC) policy.
Last reviewed in 2004, the policy reads as follows: A device in which ice water is put in a reservoir and then circulated through a pad by means of gravity is not considered durable medical equipment (DME). Other devices (not all-inclusive) which are also not considered to be DME are: single use packs which generate cold temperature by a chemical reaction; packs which contain gel or other material which can be repeatedly frozen; simple containers into which ice water can be placed. All of these types of devices must be coded A9270 if claims are submitted. Code E0218 describes a device which has an electric pump that circulates cold water through a pad.25
You can read the whole article here
So, as you can see, ice packs and other types of pack which you can freeze, and then use, in the home, to cool down muscles etc., along with ice machines, are not seen as “medically necessary”, and so, typically are not covered by Medicare.
How to get coverage from Medicare Part B for DME ?
Coverage from Original Medicare Part B for Durable Medical Equipment for “use in the home” is given only if –
- you are enrolled in Medicare Part B
- you have your Medicare-enrolled doctor sign a prescription certifying that the equipment is “medically necessary”
- you purchase or rent the DME through a Medicare-enrolled supplier
How does Original Medicare define “living at home” ?
Original Medicare defines “living at home” as –
- living in your own home
- living in the family home
- living in the community, such as assisted living
What happens once you have the signed prescription ?
After you have obtained your prescription –
- you need to find a Medicare-enrolled DME supplier
- only use a Medicare-enrolled “participating” supplier who accepts “assignment’ – as this means you will pay the smallest possible amount yourself
- choose the equipment which corresponds to your prescription
- wrap up all the required Medicare paperwork with the supplier, so that you comply with the Original Medicare coverage guidelines
Assuming that you have done the above, Medicare part B covers 80% of the Medicare-approved price for your DME.
And, assuming that you are purchasing or renting your DME from a Medicare-enrolled “participating” supplier who accepts “assignment”, you will then have your Medicare 20% coinsurance payment of the Medicare-approved price of the DME to cover, and your policy deductible if it applies.
Do check with the supplier before you enter into any agreement that they are a Medicare-enrolled “participating” supplier who accepts “assignment” !
Medicare-approved DME Supplier near me
You can use this link to find a Medicare-approved supplier who is local to you – Medicare.gov
Does Medicare Advantage cover air purifiers ?
Medicare Advantage plans are provided by companies contracted by Medicare to give all the Medicare services, and to cover everything that Original Medicare Parts A and B cover.
As of the fall enrollment of 2020, Advantage plans have been allowed to give coverage to certain items, such as air conditioners, under new benefits for chronic conditions.
Original Medicare does not offer these benefits.
In terms of how to get coverage and where to get the equipment, all of that depends on who your provider is, and you must ask them how to proceed.
Durable Medical Equipment generally covered by Original Medicare Part B if you qualify
If you don’t find the equipment you are looking for in my list of Original Medicare Part B covered DME’s below, you can use this link to Medicare.gov
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
Bed Side Rails
Bed Trapeze – covered if your loved one is confined to their bed and needs one to change position
Blood sugar monitors
Blood sugar (glucose) test strips
Canes (however, white canes for the blind aren’t covered)
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Cushion Lift Power Seat
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Infusion pumps and supplies (when necessary to administer certain drugs)
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mobile Geriatric Chair
Nebulizers and some nebulizer medications (if reasonable and necessary)
Oxygen equipment and accessories
Patient lifts (a medical device used to lift you from a bed or wheelchair)
Postural Drainage Boards
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Urinals (autoclavable hospital type)
Whirlpool Bath Equipment – if your loved one is home bound and the pool is medically needed. If your loved one isn’t home bound, Medicare will cover the cost of treatments in a hospital.
Prosthetic and Orthotic Items
Orthopedic shoes only when they’re a necessary part of a leg brace
Arm, leg, back, and neck braces (orthotics), as long as you go to a supplier that’s enrolled in Medicare
Artificial limbs and eyes
Breast prostheses (including a surgical bra) after a mastectomy
Ostomy bags and certain related supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.
Free on-on-one help with Medicare
SHIP – State Health Insurance Assistance Programs
All states have a SHIP, and all offer free, over the phone, counseling services on Medicare, Medicaid and Medigap.
If you need help understanding Medicare, I have a quick post outlining how to find, contact your SHIP, and to get free help – “Free Help Understanding Medicare And Medicaid ? Here’s Where You Get It”.
Does Medicaid cover air purifiers ?
All states have the option as to what can be done with Medicaid, in terms of customizing its programs to some degree.
Medicaid may frequently agree to a state’s request to waive eligibility requirements for its different programs, in order to broaden their scope and reach.
The programs on which Medicaid agrees to waive requirements are called “waivers”.
Health Care in the home – Medicaid and state programs
Health Care programs for in the home are called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”.
The programs are designed so that the participants can maintain their independence in their homes, and the community.
The programs and waivers will cover “home medical equipment” for the participants, and sometimes they will cover up to 100% of the cost.
To see if you are eligible for any programs, contact your State Medicaid Agency here.
For further information on HCBS programs, or waivers, check here on Medicare.gov –
The programs use the term “home” for the beneficiaries to mean –
- their own home
- their family home
- a group home
- an assisted living facility
- a custodial care facility
Certain programs and waivers offer greater latitude in what they are willing to consider as DME
HCBS programs, waivers and 1915 waivers which employ a system of budget self-management called either “Consumer Direction” or “Self Direction” offer a greater possibility of the beneficiary being able to buy equipment to maintain their independence than other programs.
As long as the equipment is necessary to the beneficiary being able to remain living independently, and it is within their budget, the definition of DME can be enlarged to include remodeling a home and all sorts of equipment which would not be allowed under Medicare.
To find out more about Medicaid Self Direction, click here.
The Medicaid program “Money Follows The Person”
This program was set up to help elderly adults living in nursing homes to move back to into their own homes.
Medicaid supports the individual states with the funding, so that they may either build a new program from the ground up, or to tweak an existing program.
Programs may pay for remodeling parts of the home – a kitchen or a bathroom, improve lighting, build ramps, or just buy a few grab bars. As you can see, it allows for a far greater range of DME than Medicare’s.
How to find the HCBS programs, waivers and 1915 waivers with their eligibility criteria in your state
I have put together a guide of the HCBS programs and waivers available in each state for seniors, with links to the different program websites – “Medicaid Home and Community Based Services Waivers and Programs For Seniors Listed By State”.
What’s the procedure for getting DME with Medicaid state waivers and HCBS programs ?
– the doctor, or therapist, has to provide a medical justification letter, stating it is medically necessary
– find a Medicaid-approved DME supplier, and give them the medical justification letter
– the Medicaid-approved supplier fills out a Prior Approval Application form for Medicaid
– the Prior Approval Application is sent to the Medicaid State Office
– if you are unsuccessful you will be contacted and given the reasons as to why, as well as advice on how to make an appeal
– if approved, you will receive the DME
If your income is a bit too high to qualify for Medicaid
Spend Down Programs
Medicaid’s Spend Down programs employ several methods to lower a program participant’s income level, or income + assets level, so that they may qualify for Medicaid coverage.
The methods involve allowing the deduction of certain medical and other expenses.
The two methods are called –
- Income Spend Down
- Asset Spend Down
I’ve written an article outlining how it all works, which if you want to know more you can find here – What is Spend Down ?
To find your State Medicaid State Agency
If you want to discuss things, or to email someone, you can contact your state Medicaid Agency here.
Step 1 –
Click the link to Medicaid.gov and look for the section that I have outlined in red.
Step 2 –
Select your state and click on the button they have marked “GO” – it will take you to your State Medicaid Agency with all their contact info.
State Funding Assistance
Assistive Technology Programs
All states across the US have what is called a State Assistive Technology Program, which has been designed to improve access to assistive devices in the home, primarily for the elderly and the disabled.
State Assistive Technology Programs typically have –
- an online exchange where people can post used assistive devices and medical equipment for sale, donation, or exchange – state residents can just register and participate
- a main website where you can ask about how to get access to free equipment
- reuse and refurbishment programs which are run by the state project to provide free or extremely low cost equipment for the disabled and the elderly
- some states have loan closets as part of their program, these can be either long term or short term
Assistive Technology Programs will also have registers of people who need help, and will contact them when specific equipment becomes available.
To find out more, go to your State Assistive Technology Program website.
To see what projects are in your state, click here.
Follow the steps below to see the projects in your state
Pick your state on the map or the drop-down menu, and click on “Go to state”
– I chose Florida for this example
Click on the link “Program Title” – for my example, I outlined it in red.
The AT Program state website will come up, and you can register, or use their contact info.
State Financial Assistance Programs
Some states, but not all, have non-Medicaid programs to help the elderly and the disabled to remain living independently in their own homes – this is financial assistance.
State Financial Assistance Programs will pay for assistive devices, safety equipment, durable medical equipment, as well as home modifications.
In general, the programs will pay with grants or loans, or sometimes a combination of the two.
Local Area Agencies on Aging should be able to advise you on programs for the elderly, and if there is one in your state.
You cannot get coverage for an air purifier with Original Medicare Part B for use in the home, as it is not considered to be “medically necessary”.
Air purifiers, dehumidifiers, most humidifiers, air conditioners and room heaters are not typically given coverage by Original Medicare Part B, as they are considered to be for “environmental control” and “not primarily medical in nature”.
Most bathroom safety equipment is not covered either and is considered either as convenience, or comfort items, although Original Medicare Part B will cover crutches, walkers and bedside commodes.
Original Medicare Part B will cover 80% of the Medicare-approved price for durable medical equipment for use in the home, so long as you have a prescription from a Medicare-enrolled doctor, and you used a Medicare-enrolled supplier.
You will typically be responsible for your 20% co-payment and, if it applies, your deductible.
You may qualify for Medicaid, an HCBS waiver, a 1915 waiver, or a non-Medicaid state program.
These other programs, in many cases, consider a wider range of equipment to be acceptable as DME than Medicare, often paying 100% of the cost.
You may also be able to get equipment through your State Assistive Technology Project online equipment exchange, or one of their refurbishing centers.
I’m Gareth, the author and owner of Looking After Mom and Dad.com
I have been a caregiver for over 10 yrs and share all my tips here.