Does Medicare Cover Air Purifiers ?

by | Beginners Info, Health Care

I can very much sympathize with anyone who has allergies, having been plagued with allergies to all kinds of pollens, 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 or not Medicare will help with an air purifier.

Original Medicare Part B does not cover air purifiers, as they are not considered to be “medically necessary”. Air purifiers may be covered under Medicaid waivers, HCBS programs, waivers, 1915 waivers, Assistive Technology Projects or State Financial Assistance programs if you are eligible.

What are air purifiers ?

Air purifiers are machines which filter particles from the air such as –

  • dust 
  • pollen
  • 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 – really small 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.

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 your bathroom safety equipment such as shower chairs ?

What has become clear 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, 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 –

  • crutches
  • walkers
  • 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. 

Generally what type of equipment does Original Medicare cover ?

Typically, Original Medicare Part B covers 80% of the cost of equipment for use in the home that can be classed as “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.

If Original Medicare is going to class equipment as 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 cost of the durable medical equipment and the beneficiary will be responsible for their co-payment of 20%, and also, if it applies, their annual policy deductible.

So, does Original Medicare Part B cover something like 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 to cool down muscles etc in the home, along with ice machines, are not seen as medically necessary, and so, generally are not covered by Medicare.

How to get coverage from Medicare Part B for DME’s ?

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 of the  required Medicare paperwork with the supplier so that you comply with the Original Medicare coverage guidelines

Assuming that you have done as I explained 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% co-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 with the supplier that they are a Medicare-enrolled “participating” supplier who accepts “assignment”  !

Finding a local Medicare-enrolled DME Supplier near you

You can use this link to find a Medicare-approved supplier who is local to you –  Medicare.gov

What if you have a Medicare Advantage Plan ? 

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 later in 2020 Advantage plans will be allowed to give coverage to air conditioners, and some other equipment which Medicare does not give coverage. It remains to be seen exactly which companies will be doing what – the plans have been given the right to offer new benefits for individuals with chronic diseases.

In terms of how to get coverage and where to get 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 Mediace.gov 

Air-Fluidized Bed
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
Bead Bed
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)
Commode chairs
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Crutches
Cushion Lift Power Seat
Defibrillators
Diabetic Strips
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Heat Lamps
Hospital beds
Hydraulic Lift
Infusion pumps and supplies (when necessary to administer certain drugs)
IPPB Machines
Iron Lung
Lymphedema Pumps
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mattress
Medical Oxygen
Mobile Geriatric Chair
Motorized Wheelchairs
Muscle Stimulators
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)
Oxygen Tents
Patient Lifts
Percussors
Postural Drainage Boards
Quad-Canes
Respirators
Rolling Chairs
Safety Roller
Seat Lift
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Sitz Bath
Steam Packs
Suction pumps
Traction equipment
Ultraviolet Cabinet
Urinals (autoclavable hospital type)
Vaporizers
Ventilators
Walkers
Whirlpool Bath Equipment – if your loved one is homebound and the pool is medically needed. If your loved one isn’t homebound 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
Urological supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.

Free assistance with understanding Medicare

SHIP – State Health Insurance Assistance Programs –

Your SHIP offers guidance and advice on Medicare.

This is usually a phone service, but some programs will offer face-to-face appointments as well.

You may also get advice on Medicare Advantage, Medigap and Medicaid benefits.

To find your local SHIP click on this link  here

How to contact a SHIP counselor in your state, step by step

Step 1 –

After you have clicked on the link you will arrive here –

Step 2 –

Click on one of the two buttons to find your state 

Step 3 –

Pick your state and click on it.

Step 4 –

A window will open with the contact info and a phone number for you to call in your state.

Does Medicaid cover air purifiers ?

Each state has different options as to what can be done with Medicaid.

Medicaid may frequently agree to waive eligibility requirements for its different programs 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 –

https://www.medicaid.gov/medicaid/hcbs/authorities/index.html

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 definition of the term.

What if your revenue is too high to qualify for Medicaid ?

The Spend Down Program

Simply put, Spend-Down programs reduce a person’s income level so that they may become eligible for Medicaid, HCBS’s and waivers.

The simplest method by which this is achieved, is to subtract a person’s medical expenses from their income, and if as a result their income level falls below the Medicare eligibility limit, the person will then qualify.

Unfortunately, not that many states have a Spend-Down program, but if yours does it may be just what you need.

Do check with your Area Agency on Aging, as some states have a similar program but under a different name.

 US NEWS has an article which covers the topic here.

What’s the procedure for getting DME’s with Medicaid state waivers and HBSC programs ?

Step 1

– the doctor, or therapist, has to provide a medical justification letter, stating it is medically necessary

Step 2

–  find a Medicaid-approved DME supplier , and give them the medical justification letter

Step 3

– the Medicaid-approved supplier fills out a Prior Approval Application form for Medicaid

Step 4

– the Prior Approval Application is sent to the Medicaid State Office

Step 5

– 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

Step 6

– if approved, you will receive the DME

Looking for HCBS programs, waivers and 1915 waivers and their eligibility criteria in your state

To find what is available in your state click here.

Step 1 –

Find your state on the map.

Step 2

Click on you state 

Step 3 –

Choose –

  • your state Medicaid Agency marked with a (1), or
  • your state Home and Community Based Services, Waivers and 1915 Waivers marked with a (2)

You will then see a page like the example below, with the programs and waivers in your state, and their eligibility criteria.

To find your State Medicaid State Agency

If you want to discuss things, or to email someone, you can contact you state Medicaid Agency here.

Step 1 –

Click the link to Medicade.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

 

Step 1/

Pick your state on the map or the drop down menu, and click on “Go to state”

– I chose Florida for this example

Step 2/

Click on the link “Program Title” – for my example I outlined it in red.

Step 3/

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.

    Summary

    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 and I’m the owner of Looking After Mom and Dad.com

    I have been a caregiver for over 10 yrs and share all my tips here.

    Gareth Williams

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    Does Medicare cover air purifiers ?
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    Original Medicare does not cover air purifiers, as they are not considered to be "medically necessary". Air purifiers may be covered under Medicaid waivers, HCBS programs, waivers, 1915 waivers, Assistive Technology Projects or State Financial Assistance programs if you are eligible.
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