What is Durable Medical Equipment and Why You would need it?
Durable medical equipment, or DME, is any type of medical supplies or devices that is used over and over again. An example would be a hospital bed or wheelchair. As we all age, this type of equipment is necessary to help us through the day. For those, such as seniors and elderly people, doing the basic needs of everyday life can be challenging without durable medical equipment. They assist seniors in getting in and around the house, as well as going shopping in the car. Durable medical equipment is also essential when managing an illness or disability. However, not every type of medical supplies are considered DME. The opposite of a DME is bandages or incontinence pads, which are single-use medical equipment.
So, what exactly qualifies as DME? Here are some examples of how to determine what is a DME and what is not:
The item must:
- Primarily serve a medical purpose
- Is prescribed by or ordered by a medical provider
- Is used again and again
- Have an expected lifetime of at least three years
- Be used in the home
- Useful to only patients who have an injury or disability
Some DME examples are:
- Mobility aids such as walkers, canes, crutches, wheelchairs, and scooters
- Oxygen concentrators, monitors, ventilators, and related supplies
- Kidney machines
- Traction equipment
- Personal care aids like bath chairs, dressing aids, and commodes
- Bed equipment like hospital beds, pressure mattresses, bili lights and blankets, and lift beds
Differences between Durable Medical Equipment and Adaptive Equipment
There are some similarities between durable medical equipment and adaptive equipment used as a medical purpose. However, durable medical equipment are considered reusable supplies or devices, whereas adaptive equipment is for long-term or short-term uses, putting them in a different type of category. An example is that of a senior with a disability and needs a handheld showerhead to help with bathing. Unlike durable medical equipment, an adaptive device does not necessarily have to serve a medical purpose. For instance, grab bars in the bathroom. They can be installed for the sole purpose of helping with balance, the senior may or may not have a medical condition.
There is also some adaptive equipment for mobility purposes, such as wheelchairs, canes, and scooters. These are also a type of durable medical equipment. Below is a short list of types of adaptive devices and supplies seniors can use for either activities of daily living or mobility purposes. The items will help make dressing, bathing, toileting, and eating better. They can also assist in communication and allow mobility easier, safer, or more accessible. Keep in mind, although each item is very helpful for seniors or any disabled individual to use, it is not considered a durable medical equipment, hence, not covered by insurance. However, some items may pose an exemption, such as a cane, wheelchair, or commodes; which are medically necessary to those using them.
Adaptive Equipment (for ADL and Mobility) examples:
- Shower chair
- Handheld showerhead
- Transfer board
- Grab bars
- Hearing aids
- Screen readers
- Fall detection devices
- Amplified telephone equipment
- Wheelchair accessible vehicles
Can Hearing Aids be considered Durable Medical Equipment?
Unfortunately hearing aids are not listed as a DME. An individual may wear them every day and basically for more than three years, yet they are not considered medically necessary or classified as a DME. They are, however, classified as elective or Class I medical devices. Class I devices are by definition not qualified as a DME. Yet hearing aids are listed as a type of adaptive equipment to seniors. Because of this, they are not covered by Medicare.
Is Durable Medical Equipment covered by Medicaid?
As far as Medicaid, what they cover will vary by each state. Calling your local Medicaid office or visiting their online website can give seniors more information of what type of medical equipment is covered. There are certain DME that will be accepted and covered through Medicaid, if they meet the state’s definition as a DME-approved item. However, there are certain Medicaid programs that will cover 100 percent of the cost to seniors.
Here are basic steps to receive Medicaid coverage for durable medical equipment:
- Receive a medical justification letter from your medical provider that outlines why you need the item.
- Choose a Medicaid-approved supplier and provide them a copy of the letter.
- The supplier then fills out a prior approval (PA) application and sends it to the state Medicaid office.
- The Medicaid office of your state either approves or denies the claim.
- If approved, the supplier sends you the DME and sends the bill to Medicaid.
- However, if it is denied, the senior will receive an outlined letter stating why, including an option to appeal the decision.
- This is just an example, the total process may vary depending on where you live.
Does Medicare cover Durable Medical Equipment?
Similar to Medicaid, Medicare will also cover certain types of DME to seniors. According to their website, Medicare Part B will cover DME as long as it is prescribed by your medical provider for home use. Check the list below for more information.
Types of DME covered by Medicare
Here is a list of the most common types of DME covered by Medicare.
- Mobility aids: walkers, wheelchairs, scooters, crutches, canes, and patient lifts
- Diabetes supplies: blood sugar meters, blood sugar test strips, lancets, and lancing devices
- Breathing equipment: nebulizers, nebulizer medications, oxygen equipment and accessories, and CPAP devices
- Continuous passive motion devices
- Commode chairs
- Hospital beds
- Pressure-reducing support surfaces
- Infusion pumps and supplies
- Suction pumps
- Traction equipment
Types of DME not covered by Medicare
- Single-use items, such as incontinence pads or surgical face masks
- Items purchased from a supplier or business that does not accept Medicare payments
- Equipment with a primary purpose to help seniors working outside of the home
- Items designed to improve your comfort or add convenience, such as grab bars, air conditioners, or toilet seats
- Home modifications, such as widened doors or ramps
Generally, Medicare will cover 80 percent of the total cost of a medical product, device, or supplies. That leaves the senior or disabled individual to pay the remaining 20 percent of the Medicare-approved amount. Part B deductible also applies here. Seniors just need to make sure that both the doctor prescribing the equipment and the supplier are enrolled in Medicare. Medicare will not pay the claims if they are not.
Other Ways to Pay for Durable Medical Equipment
In some cases, Medicare or Medicaid will not pay for an item seniors need. This is also helpful if the person does not want to wait to find out if what you need is Medicare- or Medicaid-approved. So here are some other options for seniors to pay for durable medical equipment:
- Nonprofit or state assistance: For some nonprofits, national foundations, and state-assisted programs, they provide help to seniors by paying for durable medical equipment through grants, low-interest loans, assistive technology programs, and financial aid programs. Seniors or any disabled individual should visit their state’s website or call their local Area Agency on Aging office for assistance in locating available programs.
- Private insurance: Many private insurers will cover durable medical equipment (DME). Seniors should contact their private insurer directly to find out specific details about what coverage is approved. There also may be a deductible to be met before approval.
- Private pay: Paying for equipment yourself is always an option, even when insurance is available. However, it can be pricey. Some seniors choose this option anyway because they find that it is quicker than waiting for approval from the insurer. Especially if you need the equipment fast. Be aware of the consequences and the cost difference when choosing to pay for something privately that Medicaid, Medicare, or another insurance policy would normally cover. Another good option is looking to buy DME items secondhand. They often are half the cost. Consider checking thrift stores, classified markets, or eBay for deals.
- Veterans health care: There are always benefits to being a military service member or a military family member. Veterans and their spouses can find assistance through the Department of Veterans Affairs for help with many Medicare-approved items. Sometimes a copayment for the DME or with the entire cost of DME is required as payment. The VA has a variety of programs available to help seniors with the cost, such as CHAMPVA benefits and Tricare.
Finding a Medicare-Approved Durable Medical Equipment Supplier in my Area
For those who want to get things done fast and in the most simplistic way to find local Medicare-approved DME suppliers, then seniors should use Medicare’s official Find Medical Equipment and Suppliers search tool. It allows the person to find a supplier’s name to see if they participate in Medicare, or the senior can search by typing in a kind of equipment they need and find a supplier that has it. Seniors can also contact Medicare themselves for the right answers they are looking for.
How seniors can contact Medicare:
- Online: Log in to your secure Medicare account
- Phone: 1-800-MEDICARE (1-800-633-4227)
- TTY: 1-877-486-2048