Does Medicare cover scales ?
With so many elderly loved ones suffering from illnesses related to surplus weight, scales are very important devices to help our loved ones monitor any weight gains or losses. And as with all other pieces of equipment that we need for them, we have to ask the inevitable question….
Does Medicare cover scales ? No, Original Medicare Part B does not cover scales for “use in the home”, as they are not an item which it considers to be “medically necessary”. There are other sources of funding such as Medicaid, HCBS waivers, 1915 waivers, State Assistive Technology Projects and State Financial Assistance programs which may help if you qualify for coverage.
Will Medicare cover your bathroom safety equipment ?
You may not have been surprised to discover that Medicare doesn’t cover scales, but I think you may be surprised at how much bathroom safety equipment is not covered by Medicare.
Rather a lot of bathroom equipment that is associated with safety, and with making personal hygiene easier, which you may have thought would be covered by Medicare, is not.
I used to think, before researching Medicare, that the more obvious items such as grab bars, raised toilet seats or shower chairs, or anything in fact associated with creating a safer bathroom environment for our elderly parents, would probably have some kind of coverage ……WRONG !!!
Medicare is not there to help prevent elderly from having accidents in the home.
All that Medicare covers has to be “medically necessary”, and as you will see if your read to the end, this does differ from other funding sources which are there to provide equipment which helps the elderly with avoiding accidents, or just makes living at home possible.
Medicare, for instance, does not cover any of the following –
- grab bars
- raised toilet seats
- bath lifts
- bath seats
- floor to ceiling poles
- shower chairs
- bath chairs
- transfer seats
- toilet safety frames
Thankfully though, when it is medically necessary for the elderly with mobility problems, Medicare does cover crutches, walkers and bedside commodes, all of which can be very useful in the bathroom.
To get coverage the equipment must be prescribed by a Medicare-enrolled doctor and be “medically necessary”.
In the case of this type of equipment, it means that the person cannot stand without the aids, and these will necessarily improve their quality of life and help with their condition, especially in the bathroom.
I have a long article with 50 plus safety tips that I have learned over the 11 years that I have looked after my mom and dad. These are both practical tips, and some suggestions for equipment you may find helpful. You can read the article here.
If you are looking for suggestions and advice on how to make bathing easier for your parent, especially if you are assisting them, then I have another article. I discuss the ways that I have found to make the bathing a more comfortable, and dignified experience, for all parties – that one is here.
Will Medicare cover exercise equipment ?
Exercise equipment is not considered “medically necessary” by Original Medicare along with, in most cases, exercise classes.
The use of exercise equipment though, is covered by Original Medicare Part B when it is in treatment sessions with physiotherapy and occupational therapy, where it is prescribed as “medically necessary” by a doctor.
The treatment must be given on an outpatient basis by a Medicare-certified therapist, and the therapy must be under regular review by the prescribing doctor.
As with any medical equipment, you will need to make sure that the therapist charges the Medicare-approved fee for the therapy in question.
If you do everything by the book, Medicare typically covers 80% of the Medicare- approved fee, and the patient covers the 20% of the fee, plus their deductible if it applies.
With a Medicare Advantage plan some have coverage for exercise plans and gyms, but always check with the provider before signing up for anything.
Does Medicare Part B cover a walking boot ?
An example of a piece of equipment which is, in some cases, covered is a “walking boot”.
“Walking Boots” are covered under the benefit for Orthotics or Braces by Medicare Part B, for certain types of boot, and for certain types treatments only –
- the “walking boot” has to be rigid or semi rigid
- the treatment it is used for, must be to immobilize the ankle/foot following orthopedic surgery, or for an orthopedic condition
As per all Medicare coverage, it is necessary to have a signed prescription from a Medicare-enrolled physician which says the “walking boot” is “medically necessary”.
Medicare will not give coverage to “walking boots if they are used to relieve pressure to treat ulcers and foot sores associated with diabetes, or other conditions. .
Medicare Part B covers therapeutic shoes and inserts for conditions such as diabetes, but not under the benefit for Orthotics or Braces.
How often does Medicare pay for a walker, or equipment ?
Medicare Part B’s policy is to replace DME that you rent, or own, if they are –
- worn out through use
- have been in your possession for their entire lifetime
- so worn out that they can’t be fixed
- five years is the minimum period considered to be a lifetime for an item
- the lifetime can vary depending on the type of equipment
If you have a worn out walker, Medicare Part B will typically replace it every five years, so long as it has only been yours, and that the walker is beyond repair.
If an item has worn out prior to the end of its lifetime, Medicare will pay to have it repaired, unless it’s the case that the repair is more costly than a replacement .
The process for obtaining the replacement item is the same as the initial process for the first item with coverage – a prescription from a Medicare-enrolled doctor stating that equipment is medically necessary.
What does Medicare call the equipment it covers ?
The name given to the equipment which Original Medicare covers is Durable Medical Equipment, or DME for short.
Durable Medical Equipment which is “for use in the home” is covered by Original Medicare Part B.
Durable Medical Equipment which is used in skilled nursing facilities is covered by Original Medicare Part A.
Durable Medical Equipment must fulfill following criteria –
- it must withstand repeated use over a sustained period of time – durable
- it is to be used for medical reasons only – not for comfort
- it’s got to be useful to a person who is sick, and not to those who aren’t
- it is to be used primarily in the home
- it must be expected to last a minimum of 3 years
How do your DME qualify for Medicare coverage ?
To get coverage of DME “for use in the home” with Original Medicare Part B, you –
- must be enrolled in Medicare Part B
- need a signed prescription from your Medicare-enrolled doctor saying that the DME is “medically necessary”
- have to go through a supplier who is a Medicare-enrolled supplier
To qualify for DME for “home use” –
You must be –
- living in your own home
- living in the family home
- living in the community, such as assisted living
What do you do with your prescription from your Medicare-enrolled doctor ?
With the prescription in hand, you should do the following –
- locate a Medicare-enrolled DME supplier who has your type of DME
- make sure the supplier is a Medicare-enrolled “participating” supplier who accepts “assignment’ – this ensures you don’t pay any surplus
- although the equipment Medicare gives coverage is only the basic models, you can in certain cases, if you pay extra, get upgrades
- select the example you want of the DME from those you have been prescribed
- complete all of the necessary paperwork with the supplier, in compliance with any Medicare rules
If you have used a Medicare-enrolled supplier and your prescription is from a Medicare-enrolled doctor stating that your DME is “medically necessary”, Medicare part B will cover 80% of the Medicare-approved price for DME.
If you have used a Medicare-enrolled “Participating” supplier who accepts “assignment”, you’ll only pay your Medicare 20% co-payment of the Medicare-approved price for the DME, as well as your deductible if it applies.
Always purchase or rent from a Medicare-enrolled supplier who is a Medicare-enrolled “Participating” supplier who accepts “assignment”, as they have accepted to charge just the Medicare-approved price for equipment.
If a Medicare-enrolled supplier is not a “Participating” supplier who accepts “assignment”, it means that the supplier can add up to 13% to the Medicare-approved price for the equipment, and it will paid by you, and not by Medicare.
Medicare may rent or purchase your DME – in cases where Medicare decides to rent the DME, rather than purchasing it, you will have the same payment structure as for purchased equipment – you will simply pay a monthly 20% co-payment of the monthly rental fee, plus a one time payment of your deductible, if it applies.
Locate a Medicare-enrolled DME Supplier near you
To find a local Medicare supplier check this here at Medicare.gov
Do Medicare Advantage Plans cover exercise equipment ?
If you have a Medicare Advantage Plan you are covered for everything that Original Medicare Parts A and B cover. You will have at least the same coverage for DME for “use in the home”.
The process for assuring coverage, and for then purchasing the DME will vary from provider to provider, as each plan will have its own network of doctors and suppliers that they will want you to use.
Always contact your plan provider before you get any equipment.
Durable Medical Equipment generally covered by Medicare if you qualify
If you don’t find the equipment you are looking for in my list of Medicare covered DME below, you can use this link to Mediace.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 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
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.
DME usually not covered by Medicare
Augmentative Communication Device
Bed Exit Alarms
Bed Sensor Pads
Beds – Lounge
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
Contact Lenses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens
Disposable Bed Protectors
Door Exit Alarms
Electrical Wound Stimulation
Exit Alarm Mat
Eye Glasses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens.
Heat and Massage Foam Cushion Pad
Heating and Cooling Plants
Humidifiers – not room humidifiers
Injectors (hypodermic jet pressure powered devices for Insulin injection)
Motion Sensor Exit Systems with Pagers
Over bed Tables
Paraffin Bath Units (if not Portable)
Portable Room Heaters
Portable Whirlpool Pumps
Preset Portable Oxygen Units
Pull String Alarms
Raised Toilet Seats
Special TV Close Caption
Speech Teaching Machines
Surgical Face Masks
Telephone Alert Systems
Television Assistive Listening Devices
Walk in Bathtubs
Get free assistance with understanding Medicare
SHIP – State Health Insurance Assistance Programs – give free help with understanding Medicare.
SHIP helps people with Medicare, Medicare Advantage, Medigap and Medicaid benefits.
Generally it’s a phone service, but sometimes the programs may offer in-person appointments as well.
To find local Medicare help in your state click on this link here
How to get in touch with a free SHIP counselor in your state, step by step
Step 2 –
Click on one of the two buttons to find your state – they both lead to the same menu to choose your state
Step 4 –
The screen will open a window with the contact info and a phone number for you to call in your state.
Will Medicaid cover scales or any kind DME ?
Medicaid has dual funding, – both federal and state sources – and as a result each state in the US can have a certain amount of leeway in what its health programs do, as long it adheres to basic Medicaid guidelines.
Medicaid will often allow states to waive certain of the eligibility criteria for various programs, so that different groups of people, who may otherwise have been missed, will instead qualify and receive health care.
These programs are then called waivers.
Each waiver will have its own eligibility criteria, in order that it may help a specific group of people.
Care in the home – Medicare and state programs
The programs which are specifically for care in the home and the community are called – “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”
The goal of these programs is to help the beneficiaries to maintain their independence, and to remain living in their own homes, and the community.
These programs are for low income families, disabled individuals and the elderly.
If you contact your State Medicaid Agency you can find out if you are eligible here.
You can also ask at your local Area Agency on Aging about waivers for the elderly in your state.
To learn more about HCBS programs, or waivers use the link below –
To avoid unnecessarily placing the elderly and the disabled in state care facilities, and to keep them in their own homes, the HCBS programs, waivers and 1915 waivers, cover a wide range of home medical equipment, and will often cover 100% of the costs.
For the purposes of the HCBS programs, waivers and 1915 waivers any of the following situations qualify as a “home” –
- their own home
- their family home
- a group home
- an assisted living facility
- a custodial care facility
Certain programs and waivers allow for a wider range of DME
Some HCBS waivers, programs, and 1915 waivers allow for “Consumer Direction”or “Self Direction” .
Each program participant will be given a budget.
The program participant is very much responsible for how the budget is spent, with the help of an appointed a financial advisor they will decide what is necessary.
These programs and waivers exist so that the participants can stay living in their own homes, so if certain equipment is necessary for them to remain independent, and the budget can cover it, they will very often be allowed get it.
What can be bought as DME here is far less restricted than with Medicare, as necessity, pretty much, defines what is and isn’t allowed.
You can read more about Medicaid Self Direction here.
Transitioning the elderly out of care facilities back into their homes
Money follows the person – is a Medicaid based program which helps to return elderly adults to their homes after they have been in state care facilities, so that, if they are able, they can regain their independence.
Assisted living also counts as an individual’s own home for this program.
If DME are needed for the transition they are purchased by the program – this can go as far as remodeling the bathroom, or kitchen, if it is necessary for the move to take place.
If you’re not quite eligible for Medicaid
Some states have a program called Spend Down.
Spend down is a program which helps people with income levels above the Medicaid qualification limit, to lower their income, in a way that they may be eligible for Medicaid HCBS programs, waivers and 1915 waivers.
There are a number of methods to do this, one of which is to allow you to subtract your medical bills from your income, and if you fall below the Medicaid limit, you are eligible to apply for the different forms of Medicaid assistance.
You can find a comprehensive article on the US NEWS website here.
How do you get DME with Medicaid waivers and HCBS programs ?
– get a medical justification letter from your doctor, or therapist, which states that the equipment is medically necessary
– find a Medicaid-approved DME supplier and give to them the medical justification letter
– the DME supplier should fill out a Prior Approval Application for Medicaid
– the application is then sent to the Medicaid State Office
– if your application is unsuccessful you will be notified as to the reasons why, and given advice on how to appeal the decision
– if approved you will receive the DME you applied for
How to find the HCBS programs, waivers and 1915 waivers in your state
Click on the link below and it will take you to CMS.gov (CENTER FOR MEDICARE AND MEDICAID SERVICES) to look at the different “HCBS programs”, “waivers” and “1915 waivers” offered by your state and Medicaid.
Once you select your state on the map, it will show you a section with your state waivers and programs, and also their criteria for eligibility- click here.
Step 1 – Find your state on the map.
Step 2 – Click on you state – I gave N.Dakota as an example
Step 3 – You will come to your state and it’s list of available resources, and here you can choose
- your state Medicaid Agency marked with a (1), or
- your Home and Community Based Services, Waivers and 1915 Waivers marked with a (2)
Below is an example of the type of page you will get if you click on the HCBS programs and waivers link.
You can find out what programs and waivers there are in your state, and what the criteria is for eligibility.
How to find your State Medicaid State Agency
Step 1 – Once you have clicked the link to Medicade.gov, look at the section I have outlined in the image below
Step 2 – select your state, and click on “GO” – it will take you to your State medicaid Agency.
State Funding Assistance
Assistive Technology Programs
Each state has its own Assistive Technology Programs to increase access to assistive devices – the primary focus is on the elderly and the disabled.
These assistive devices include DME and any equipment which enables a person to a complete tasks they otherwise couldn’t complete – this can range from grab bars to electronic digital devices.
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
The State AT Program website will come up, and you can
- sign up
- use their contact info to get in touch
- find out what they offer to help the elderly
- find out if you, or a loved one, are eligible
State Financial Assistance Programs
These are state non-Medicaid programs which provide assistance so that the elderly and the disabled so that they may remain living in their homes.
The programs participants get safety equipment and assistive devices, paid for with grants, loans, or a combination of both.
The programs will even cover the costs of remodeling bathrooms, wheelchair ramps and kitchen modifications – all to keep the elderly and disabled participants from being unnecessarily institutionalized.
The primary focus of these programs is on the elderly and the disabled.
Contact your local Area Agency on Aging to help you to find the programs in your area, and to see if you are eligible to participate.
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