As a carer for an elderly person, there are a lot of things you have to know, and knowing what you can and can’t get covered by their insurance is going to be one of the most important, especially if there isn’t a lot of spare money.
The only Durable Medical Equipment which is covered by Medicare for use in the home has to have been prescribed as “medically necessary” by a Medicare-enrolled by physician, or treating practitioner, and acquired from a Medicare-enrolled supplier.
What is durable medical equipment ?
Medicare defines Durable Medical Equipment as –
“Durable Medical Equipment is reusable medical equipment like, walkers, wheelchairs, or hospital beds”
Medicare Part B will not, in general, cover medical supplies which are usually disposable and not reusable – there are exceptions to this where the supplies are used in combination with DME which are covered.
Medicare’s basic criteria for DME
Durable medical equipment to be covered by Medicare Part B has to meet these following basic criteria –
- durable (it must be 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
If the equipment you are looking at doesn’t meet these criteria, it will be hard to get it covered by Medicare.
Equipment which Medicare considers to be “not primarily medical in nature”, or “for convenience” will not be covered.
These would be items such as –
- bed wedges
- bed alarms
- air conditioners
- space heaters
- raised toilet seats
- shower chairs
Now, you may have a piece of durable medical equipment which qualifies and is typically covered by Medicare, but you still have to qualify as well !
Medicare Part B, will cover DME only if –
- it has been prescribed as “medically necessary” by a Medicare-enrolled Physician “or treating provider (like a nurse practitioner, physician assistant, or clinical nurse specialist)”
- certain DME may demand 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 be purchased or rented, through a Medicare-enrolled supplier to qualify for coverage
Medical equipment used in skilled nursing facilities, including DME for short term stays, is covered by Original Medicare Part A (hospital care).
List of Durable Medical Equipment typically covered by Medicare
This is the list of durable medical equipment which, if you have qualified by all their guidelines, Medical Part B will typically cover.
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
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.
List of DME typically not covered by Medicare
This list is of equipemnt which some may consider as durable medical equipment, but which Medicare does not.
Please note that this list only covers items not covered by Medicare Parts A and B, otherwise known as Original 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
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.