Having to go back and forth for outpatient treatments can be very tiring for elderly parents, and very time-consuming for their caregivers. Treatments, such as cold and hot therapies, could possibly be given in the home if you have the right equipment.
Does Medicare cover ice machines ? Original Medicare covers cold therapy, and does so either as an inpatient, or an outpatient service. Medicare Part B, however, does not cover any form of ice machine, ice or cold therapy unit – or cooling device “for home use”.
Contents Overview & Quicklinks
Why won’t Medicare cover ice machines or cold therapy units ?
Does Medicare cover bathroom equipment ?
How often does Medicare cover a walker ?
Does Medicare cover walking boots ?
Does Medicare cover Continuous Passive Motion (CPM) devices ?
What equipment does Medicare pay for ?
Durable Medical Equipment, typically covered by Medicare
Durable Medical Equipment, typically not covered by Medicare
How do you qualify for Medicare Part coverage of DME ?
Find a local Medicare-enrolled DME Supplier near you ?
How do you proceed once you have the signed prescription for DME ?
Does Medicare Advantage cover ice machines, or cold therapy units ?
Get free assistance with understanding Medicare
Does Medicaid cover ice machines or cold therapy units ?
With certain programs and waivers, DME for home use may be easier to obtain ?
Find the HCBS programs, waivers and 1915 waivers in your state ?
What are the steps to purchasing DME with Medicaid and state, waivers and HCBS programs ?
Why won’t Medicare cover ice machines or ice/cold therapy units ?
Medicare 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 Medicare-enrolled therapist and co-signed by a Medicare-enrolled physician.
As for the equipment for cooling therapies at home
Unfortunately, though, Medicare considers that ice packs and cooling therapy items are not “reasonable and necessary”.
And, as such, they do not fall into the category of equipment which Medicare covers – Durable Medical Equipment.
The following passage is from Blue Cross Blue Shield of Rhode Island
“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.
Ice packs, and other types of pack which you can freeze and then used to cool down muscles etc in the home, along with ice machines, are considered by Medicare to be comfort items, and not medically necessary, and so, typically are not covered by Medicare.
Other examples of equipment that Medicare won’t cover, which you may have thought they would –
- bed alarms
- gauze
- adult diapers
- bed wedges
- medical alert systems
- door exit alarms
- fall alarms
- pressure stockings
All items that are extremely helpful, and often necessary, but not seen as “medically necessary” by Medicare, and so not typically covered by Original Medicare, as they are not “medically necessary”.
Of course, if your doctor says the items are “medically necessary” you may have a chance of getting them covered.
Does Medicare cover bathroom equipment ?
Bathroom safety equipment, although extremely necessary to help seniors from falling, is rarely considered “medically necessary”, and is viewed more as items “for comfort”, and so typically not covered by Medicare Part B.
Grab bars, bath chairs, bathtub lifts, shower chairs, raised toilet seats, walk in bathtubs, bathtub transfer seats, non-slip mats, floor to ceiling poles, and toilet safety frames are not covered by Medicare Part B, as they are considered to be comfort items.
If you are also concerned about bathroom safety, I have an article with over 50 tips about safety and products for your loved ones in the bathroom, gleaned from my years of looking after both Mom and Dad. You can read that here.
Happily, though, Medicare does consider a few items that you can use in the bathroom as “medically necessary” when they are prescribed by a Medicare-enrolled physician – these are walkers, bedside commodes and crutches.
Medicare Advantage Plans though are another story, and as of 2020 you may find policies which will have benefits for certain bathroom safety equipment under certain conditions.
You will see more about that in the Medicare Advantage section here.
How often does Medicare cover for a walker ?
Medicare will replace an item which is worn out, generally once every five years from the date that you received it.
So, you can replace your walker with Medicare Part B every five years, unless it has been lost, stolen or damaged beyond repair.
Equipment which has been bought and which is lost, stolen or damaged beyond repair may be replaced – you will though have to provide proof that you got the equipment through Medicare.
Source for this information is –
Medicare coverage of Durable Medical Equipment and Other Devices, CENTERS for MEDICARE & MEDICAID SERVICES.
You can read the whole document here.
The passage is on Page 13 of the PDF. You can download the document from the link.
Does Medicare cover walking boots ?
If you were looking for an ice/cold therapy machine because of an injury, or surgery, to your ankle/foot, you may be in luck, because along with walkers, rollators and crutches, Medicare will also cover ankle braces, or orthotics – commonly known as “walking boots” – and that can be for both custom-fitted, and off-the-shelf models.
If the walking boots are being used to immobilize the ankle/foot following orthopedic surgery, or for an orthopedic condition, you are eligible for Medicare coverage under the Brace benefit in Medicare Part B.
As long as you have a prescription from a Medicare-enrolled physician which states that it is medically necessary, you will typically be covered.
Does Medicare cover Continuous Passive Motion (CPM) devices ?
For those of you who have parents who need total knee replacement surgery, Medicare Part B will cover the use of CPM devices for total knee replacements, or for the revision of a previously performed total knee replacement.
CPMs are not covered for any other kind of knee surgery by Medicare Part B.
The Medicare coverage is only for the 21 days from the date of surgery.
What equipment does Medicare pay for ?
Medicare Part B covered certain durable medical equipment for use in the home if –
- the equipment is prescribed as medically necessary
- you have a signed prescription from a Medicare-enrolled physician or treating practitioner
- you acquire the equipment from a Medicare-approved supplier
Medicare’s criteria for covering durable medical equipment for use in the home are as follows –
- it’s got to be able to withstand repeated use over time – durable
- it has to be being used for a medical reason only – it can’t be a comfort item
- it is equipment that is of use to someone who is actually sick, and not of much use to someone who isn’t
- it’s primarily for use in the home
- it’s got to be expected to last at least 3 years
Durable medical equipment, typically covered by Medicare
If you don’t find the equipment you are looking for in my list of Medicare covered DME’s below, you can use this link to Medicare.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 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
Urological supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.
Durable medical equipment, typically not covered by Medicare
Adult Diapers
Air Cleaners
Air Conditioners
Alcohol Swabs
Augmentative Communication Device
Bathroom Aids
Bathtub Lifts
Bathtub Seats
Bed Bath
Bed Boards
Bed Exit Alarms
Bed Sensor Pads
Bed Lifter
Beds – Lounge
Bed Wedges
Blood Glucose Analyzers
Braille Teaching Texts
Caregiver Paging Systems
Catheters – except those which are used for permanent medical conditions where the catheter is considered as a prosthetic
Chair Exit Alarms
Chair Sensor Pads
Communicator
Contact Lenses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens
Dehumidifiers
Dentures
Diathermy Machines
Disposable Bed Protectors
Disposable Sheets
Door Exit Alarms
Easygrip Scissors
Elastic Stockings
Electrical Wound Stimulation
Electrostatic Machines
Elevators
Emesis Basins
Esophageal Dilators
Exercise Machines
Exit Alarm Mat
Eye Glasses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens.
Fall Alarms
Fans
Fabric Supports
Fomentation Device
Grab Bars
Grabbers
Gauze
Hearing Aids
Heat and Massage Foam Cushion Pad
Heating and Cooling Plants
Home Modifications
Humidifiers – not room humidifiers
Incontinence Pads
Injectors (hypodermic jet pressure powered devices for Insulin injection)
Irrigating Kits
Insulin Pens
Massage Equipment
Motion Sensors
Motion Sensor Exit Systems with Pagers
Needles
Oscillating Beds
Over bed Tables
Paraffin Bath Units (if not Portable)
Parallel Bars
Portable Room Heaters
Portable Whirlpool Pumps
Preset Portable Oxygen Units
Pressure Leotards
Pressure Stockings
Pulse Tachometer
Pull String Alarms
Raised Toilet Seats
Ramps
Reading Machines
Reflectance Colorimeters
Sauna Baths
Special TV Close Caption
Speech Teaching Machines
Stair Lifts
Standing Table
Support Hose
Surgical Face Masks
Surgical Leggings
Syringes
Telephone Alert Systems
Television Assistive Listening Devices
Telephone Arms
Toilet Seats
Treadmill Exercisers
Walk in Bathtubs
Wheelchair Lifts
Whirlpool Pumps
White Canes
Wigs
How do you qualify for Medicare coverage of DME ?
For your parent to qualify for DME with Medicare coverage “for use in their home”, your parent –
- has to be enrolled in Medicare Part B
- has to have their Medicare-enrolled doctor give them a signed prescription which states that the equipment is a “medically necessary”, and that it meets the Medicare criteria for that particular piece of equipment
- has to make the purchase of the equipment from a Medicare-enrolled supplier
For Medicare part B, “living at home” is –
- living in your own home
- living in the family home
- living in the community, such as assisted living
Nursing homes and hospitals are covered under Medicare Part A – hospital treatment – and do not qualify as a home. The coverage for DME is different here, and they are provided for up to 100 days by the nursing facility.
Durable medical equipment supplier near me
To find a local Medicare supplier near you, check this link at Medicare.gov
How do you proceed once your parent has a doctor’s signed prescription for a DME ?
As long as Medicare Part B is satisfied that your parent’s DME is “medically necessary”, they will cover 80% of the Medicare-approved price for the DME.
Your parent will then be responsible for paying their Medicare 20% co-payment of the Medicare-approved price of the DME, as long as they have used a Medicare-enrolled “participating” supplier who accepts “assignment”.
If not, your parent may owe much more !
Your parent will also have to pay their deductible, if it hasn’t already been met.
Medicare may purchase or rent DME
Depending on the cost of an item, Medicare either purchases it outright or they rent it.
Generally, with all but the less important purchases, Medicare will rent equipment on a monthly basis from a DME supplier.
For the duration of the rental period as long as the DME is rented from a Medicare-enrolled “participating” supplier who accepts “assignment”, your parent will pay a monthly co-payment of 20% of the Medicare-approved rental price.
How to avoid over-paying for the equipment ?
Your parent needs to be meticulous in following all the steps of the process with Medicare, so that they get the best coverage for their equipment.
To avoid paying any extra for their DME, your parent must use a Medicare enrolled “participating” supplier who accepts “assignment”.
This ensures the DME is being bought for the Medicare-approved price, which is as low as it gets, and their co-payment will be as low as is possible as a result.
How does this happen ?
There are two types of Medicare suppliers –
- Medicare Suppliers
or
- Medicare “Participating” Suppliers
Medicare and Medicare “Participating” Suppliers have an agreement that Medicare “Participating” Suppliers will accept what is called “assignment” – this means that they will only charge the Medicare-approved price for DME.
Suppliers who are not “Participating” can charge up to 15% more for the DME, and as Medicare will only pay the supplier their Medicare-approved price, it leaves your parent to pay the difference, as well as their co-payment and deductible (if it applies).
Does Medicare Advantage cover ice machines, or cold therapy units ?
Medicare Advantage Plans are run by private companies which have been contracted by Medicare to provide Medicare services and who must, by law, provide at least the same coverage and services, as Original Medicare Parts A and B.
As of 2020, things have changed a little, and Medicare is trying to make Medicare Advantage Plans more competitive by expanding the range of extra benefits they are allowed to offer over and above that of Original Medicare.
Certain benefits are now allowed for individuals with some chronic conditions, and of these benefits some are for bathroom safety equipment.
You will of course need to find the precise plans offering these benefits.
For the precise terms, processes, and which DME suppliers to use, your parent must consult with their provider, if they have a Medicare Advantage plan.
Get free assistance with understanding Medicare
SHIP – State Health Insurance Assistance Programs
SHIPs offer free phone counseling services on Medicare, Medicaid and Medigap – in some instances the services are in person.
To find your local SHIP and, you can check out my very quick guide – “Free Help Understanding Medicare And Medicaid ? Here’s Where You Get It”.
Does Medicaid cover ice machines or cold therapy units ?
Medicaid is a very different beast from Medicare, and is funded both on a federal level and a state level.
The states have a lot of latitude in what they can do, as long as they stay with basic guidelines, and a lot of Medicaid programs for outside skilled nursing care facilities have been developed.
One of the results of this, is that there are literally hundreds of different “programs” and “waivers” across the US, and which vary greatly from state to state.
Medicaid and state programs for care services in the home
These programs are called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”, and all with their differences and specificities.
The programs and waivers are intended for those on very low incomes, and your parent will have to find if they are eligible. All of this can be done at your parent’s State Medicaid Office.
The aim of these programs and waivers is to help the beneficiaries to maintain their independence in their own homes.
Your local Area Agency on Aging should be able to help you find out as well.
For a much more technical and full explanation of these programs, follow this link to medicaid.gov –
https://www.medicaid.gov/medicaid/hcbs/authorities/index.html
The programs and waivers pay for “home medical equipment”, but unlike Medicare, they often cover 100% of the cost of the equipment.
For the programs and waivers, the term “home” is used to mean that the beneficiary has to be living in –
- their own home
- their family home
- a group home
- an assisted living facility
- a custodial care facility
With certain programs and waivers, DME for home use may be easier to obtain
HCBS programs and waivers can apply what is known as “Consumer Direction” or “Self Direction”
If this is the case, the participant will have an allotted budget to help them maintain their independence in their home. A financial planner is also appointed to assist each participant in managing the funds across their living needs.
If judged “medically necessary” and integral to the participant maintaining their independence in their home, equipment such as toilet safety frames, bathtub lifts, grab bars, not covered as DME by Medicare, can be purchased on some of these programs, or waivers, if it’s within the person’s allotted budget.
To find out more about Medicaid Self Direction, click here.
Transitioning the elderly from care institutions back into their homes
Money follows the person – a Medicaid based program – transitions elderly adults, from nursing facilities back into their homes – this can also be assisted living.
Equipment which is needed to make this happen is purchased by the program. What is considered a DME that is “medically necessary” can again be quite different from that considered so by Medicare.
Find the HCBS programs, waivers and 1915 waivers in your state
If you wish to learn more about the HCBS Waivers, 1915 Waivers, HCBS Programs and the Money Follows The Person Programs for seniors which are available in your state, I have an article listing what is offered in each state, along with links to the different program websites. The article also includes of all the PACE Programs – Programs of All-inclusive Care for the Elderly – offered –“Medicaid Home and Community Based Services Waivers and Programs For Seniors Listed By State”
What are the steps to purchasing DME with Medicaid and state, waivers and HCBS programs ?
Step 1
– the beneficiary has to get the doctor, or therapist, to provide a medical justification letter, which states that the equipment is medically necessary
Step 2
-the beneficiary has to find a DME supplier who is Medicaid-approved, and to pass on to them the medical justification letter
Step 3
– the DME supplier then fills out a Prior Approval Application for Medicaid
Step 4
– the document is then sent to the Medicaid State Office for approval or denial
Step 5
– if the beneficiary is unsuccessful they will be notified as to the reasons why, and told how to appeal the decision
Step 6
– if approved, the beneficiary will receive the DME
If your income is a bit too high to qualify for Medicaid
Spend Down Programs
Medicaid Spend Down programs work to lower a program participant’s income level, or the income level + asset level, so that they may qualify for Medicaid coverage, by allowing the deduction of certain expenses.
The two methods are called –
- Income Spend Down
- Asset Spend Down
I’ve written a short post about how it works, which you can find here – What is Spend Down ?
To find your State Medicaid State Agency
If the documents are too technical, I wouldn’t waste your time trying to work your way through them, I would contact your state Medicaid Agency, and you can do that here.
Step 1 – Once you have clicked the link to Medicaid.gov, just look over to the right on the website page, and you will see the section I have outlined in the image below
Step 2 – select your state and click on the button they have marked “GO” – it will take you to your State Medicaid Agency, and you will be able to get all the contact info and make calls or write emails to get all the help you need.
State funding assistance
Assistive Technology Programs
These are programs which help to increase access to assistive devices in the home.
The elderly are one of the primary focuses.
“DME” and “Assistive Technology” are very interchangeable as terms, so participants are able to get a wide range of different medical devices to help them in their homes.
To find out what programs your state runs, click here.
Step 1/
Select your state on the map or from the drop-down menu and click on the button “Go to state”
– I chose Florida for this example
Step 2/
Look for the link “Program Title” – for my example I outlined it in red – and click on that.
Step 3/
The State AT Program website will come up, and you can sign up, or use their contact info to get in touch and find out what they offer to help the elderly, and if you, or a loved one are eligible.
State Financial Assistance Programs for the elderly
In an effort to reduce the number of elderly persons entering into the Medicaid run nursing homes, non-Medicaid state programs are being developed to help them to remain living independently in their own homes.
These programs are run by individual states, and not every state has one.
Eligibility differs with each program in each state, so your parent will have to find the programs – again, the Area Agency on Aging should be able to point them in the right direction.
The programs do work such as modifying homes, and purchasing equipment necessary to the goal of helping the elderly and disabled to maintain their independence in their home.
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.
