Medicare Part B provides out-patient medical care for Medicare recipients who are enrolled in Original Medicare or Medicare Advantage. Part B helps pay for durable medical equipment (DME) such as hospital beds, wheelchairs, oxygen equipment, and other medically necessary supplies and equipment that is prescribed for home use. For many seniors, coverage of DME is a huge blessing. It’s worth taking a minute to understand what equipment is covered and some of the restrictions around the coverage.
If you have a question about whether Part B covers a particular type of durable medical equipment or whether specific equipment can be owned or must be rented, call 1-800-MEDICARE (1-800-633-4227) or contact your Medicare agent.
What you need to know about Part B coverage for medical supplies and equipment
1. Equipment must be prescribed by a doctor for home use.
2. Equipment must be purchased or rented from a Medicare enrolled supplier that has a Medicare supplier number.
3. Some equipment must be rented, while other equipment is purchased.
4. Generally, you pay 20% of the Medicare-approved amount after you pay your Part B deductible for the year.
5. A hospital or nursing home where you are temporarily residing for Medicare-covered care does not qualify as your “home” but a long-term care facility can.
6. If your owned equipment needs maintenance or repairs, visit Medicare.gov/supplierdirectory to find a repair person.
7. If your rented equipment needs maintenance or repairs, your supplier must repair or replace the equipment. If your supplier doesn’t respond to your requests, call 1-800-MEDICARE.
8. If your equipment or supplies are lost or damaged in a disaster or emergency, Medicare will cover the cost to replace your equipment or supplies under some circumstances. If Medicare agrees to cover the cost to replace your equipment or supplies, they will also cover the cost of loaned equipment for items while your equipment is being repaired.
What Medicare covers for durable medical equipment & other supplies
The following list of Medicare covered durable medical equipment and other devices is provided by the Department of Health & Human Services in this official government booklet:
Durable medical equipment
Pressure-reducing beds, mattresses, and mattress overlays used to prevent bed sores
Blood sugar monitors
Blood sugar (glucose) test strips
Canes (except for white canes for the blind)
Surgical dressings or wound care supplies
Continuous passive motion (CPM) machines
Infusion pumps and supplies (when necessary for administering certain drugs)
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
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)
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Prosthetic & orthotic items
Arm, leg, back, and neck braces (orthotics)
Artificial limbs and eyes
Breast prostheses (including a mastectomy bra) after a mastectomy
Ostomy bags and certain related supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease
Cataract glasses (for Aphakia or absence of the lens of the eye)
Standard glasses frames or contact lenses after surgery with insertion of an intraocular lens
If you have specific questions about the cost or coverage of DME, call 1-800-MEDICARE (1-800-633-4227) or contact your Medicare agent. Medicare agents are ready to support you.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.