Medicare Part B is not free, by any means, and neither is the equipment that it covers, but in certain situations, it will greatly reduce the cost of the equipment to the beneficiary if they qualify.
It can get a little complicated to understand exactly when you are covered, for what, and to what extent, but I will do my best to explain when it can greatly reduce the equipment bills.
What medical equipment does Medicare cover ?
Original Medicare Part B, covers some items of durable medical equipment for use in the home, with certain stipulations.
Durable medical equipment is medical equipment which is able to withstand repeated use over a sustained period of time, as opposed to medical supplies which are disposable, and not covered by Medicare Part B.
Medicare’s basic criteria for DME
Medicare will not cover any type of durable medical equipment.
If Medicare Part B is to cover durable medical equipment, it must be:
- durable (able to withstand repeated use over a sustained period of time)
- used for a medical reason, as opposed to for comfort
- not usually useful to someone who isn’t sick or injured
- used in your home
- has an expected lifetime of at least 3 years
So, straight away, if the equipment you want doesn’t meet these criteria, you most likely will not be able to get it covered by Medicare.
Medicare will not cover equipment which it sees as “not medical in nature”, or “comfort items”, and unfortunately for many seniors this includes a lot of bathroom safety equipment –
- grab bars
- raised toilet seats
- toilet safety frames
If you want to know the durable medical equipment which is typically covered by Medicare Part B, under their guidelines, you can see that in my article “List Of Durable Medical Equipment Typically Covered By Medicare”
How much can you potentially save on durable medical equipment with Medicare Part B ?
Although Medicare Part B won’t get you free medical equipment for home use, it can, in some scenarios, greatly reduce your spending on medical equipment.
Before buying or renting anything –
1) Prior to purchasing, or renting, any durable medical equipment which you are hoping to get covered by Medicare Part B, you must make sure –
- to get a signed prescription from a Medicare-enrolled physician, or treating provider (such as a nurse practitioner, physician assistant, or clinical nurse specialist), stating that it is “medically necessary”
- some types of durable medical equipment may require extra documentation of the “medical necessity” of the equipment – Source : https://www.medicare.gov/Pubs/pdf/11045-Medicare-Coverage-of-DME.PDF
- the equipment must also be acquired (purchased or rented), through a Medicare-enrolled supplier to qualify for coverage
- that you purchase or rent your durable medical equipment from a medicare-approved medical equipment supplier
2) If you want to pay the lowest possible amount for your equipment, you must use a Medicare-approved supplier, who is a “Participating Supplier” who accepts “Assignment”.
The Participating Suppliers have agreed to only charge the Medicare-approved price for any durable medical equipment, they cannot add any extra.
How much will you pay for DME when Medicare Part B accepts to cover an item ?
In cases where Medicare Part B accepts to cover an item –
- you will pay 20 % of the Medicare-approved purchase or rental price, and any extra amount the supplier has added to that price (if they are not a participating supplier)
- if you have not already paid your annual deductible ($233.00 in 2022), you will also have that to pay
This does make it seem rather pointless to use Medicare Part B coverage to pay for cheaper items, if you are going to have to pay your annual deductible.
But this is not the case on more substantial items such as a hospital bed, or anything over $400.00.
It may be worth trying to get coverage from Medicare Part B, even if you have to pay your annual deductible.
Example of savings on different items if you have to also pay your annual deductible
Note: for all examples in this article, you need to be acquiring the items from a “Participating” Medicare-approved supplier who accepts “assignment”.
Example 1/ a $50.00 walker (Medicare-approved price)
You pay Medicare annual deductible = $233.00
You pay the 20% co-insurance of the Medicare-approved price of $50.00 = $10.00
The total you will pay = $233.00 + $10.00 = $243.00
You will end up paying an extra $193.00 for a $50.00 walker
So, this makes no sense on cheaper items unless you have already paid your annual deductible – and we will come to that in a minute.
Example 2/ a $500.00 hospital bed (Medicare-approved price)
You pay Medicare annual deductible = $233.00
You pay the 20% co-insurance of the Medicare-approved price of $500.00 = $100.00
The total you will pay = $233.00 + $100.00 = $333.00
Your saving will be = $167.00 by using Medicare Part B
So, the above purchase or rental makes good sense.
Even in a case where an item costs $400.00, and in which you also have to pay your annual deductible, you will save $87.00.
But this all changes if you have already paid your Medicare Part B annual deductible in the given year, then it is to get your Medicare Part B coverage to pay for any durable medical equipment, as Medicare will cover 80% of the cost of your item, and you will just cover the co-insurance.
Examples of savings on different items if you have already paid your annual deductible
Example 1/ a $50.00 walker (Medicare-approved price)
You pay the 20% co-insurance of the Medicare-approved price of $50.00 = $10.00
The total you will pay = $10.00
You will save $40.00 on the $50.00 walker
So, this makes perfect sense on cheaper items now.
Example 2/ a $500.00 hospital bed (Medicare-approved price)
You pay the 20% co-insurance of the Medicare-approved price of $500.00 = $100.00
The total you will pay = $100.00
You will save = $400.00 on a $500.00 hospital bed
So, once you have paid your deductible, the savings are huge.
What if you have Medigap or a Supplemental Plan ?
Medigap and supplemental plans are extra policies that individuals can buy so that they do not have to pay their 20% coinsurance on Medicare Part B.
This would mean in the that in the examples shown, there would be no 20% coinsurance to pay each time equipment which Medicare Part B has agreed to cover, is bought. It is covered by Medigap or other supplemental plan.
It still is not free equipment, as you are paying for your Medicare Part B coverage, your annual deductible (on the first item only in the insurance term), and your Medigap or supplemental policy.
Other places to find free durable medical equipment
If this doesn’t work for you, look into the following places in your area to find free medical equipment, and see if you qualify –
- your state Assistive Technology Program
- community loan closets
- resuse centers for durable medical equipment
Where to ask about free medical equipment in your neighborhood
If nothing has helped you so far, you may want to inquire at some following locations in your neighborhood –
- Your local Area Agency on Aging
- Your local social services
- Lions Clubs
- Rotary Clubs
- Local church communities and faith groups
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.
