Durable Medical Equipment (DME) and Medicare Coverage

Older adults have many medical needs that are unique to their age and physical condition, and sometimes they need special equipment to stay healthy and active. Durable medical equipment (DME) is a class of medical supplies that covers a wide range of items.

DME devices can improve the mobility of people who have trouble getting around after an illness or operation, and the term also covers safety devices that can prevent injuries in the home. Seniors can get durable medical equipment from several sources, and often, help is available for some or all of the cost.

What Is DME?

What is DME? Durable medical equipment is a broad category of medical supplies that includes safety devices, personal medical appliances and several types of rehabilitation and therapeutic appliances. Broadly, DME falls into three major categories:

Safety Devices

Safety devices many seniors have in their homes include shower chairs and guard rails, lift bars and bumpers for sharp edges. Medical call buttons and lifeline alert systems are typically classified as safety devices, as are window and door alarms or cabinet safety locks for seniors with Alzheimer’s disease and other forms of dementia.

Some orthopedic braces and other wearable devices are intended primarily to prevent injury, and they may also be considered safety equipment.

Mobility Aids

Many seniors experience increasingly limited mobility as they age. A number of DME items can help them stay active. These may be simple devices that only occasionally get used, such as mechanical reaching aids and walking canes.

Leg and back braces, scooters, wheelchairs and even stairlifts or elevators can be considered mobility-based durable medical equipment as well.

Therapy Equipment

Some DME is intended to help seniors recover from injury or to improve a medical condition. Eyeglasses, dentures and orthopedic shoes are in this category, as are prosthetic devices and some exercise tools. Adjustable beds are often regarded as medical equipment, if they are needed for help managing a chronic condition, such as sleep apnea or congestive heart failure.

Oxygen is not technically a piece of medical equipment, but the tanks, regulators, masks and tubing needed to deliver it can be.

What Is Not Durable Medical Equipment?

Not every item an older adult needs for safety, mobility or therapy counts as durable medical equipment. Gauze bandages, for example, are disposable supplies.

Most gloves, sanitary pads and bed liners are also disposable, as are single-use items such as transdermal patches or lancets used for a single finger stick. Diabetes test strips are not considered DME, though the blood sugar monitor that reads them is. Eyeglasses are durable medical supplies, though most contact lenses are not.

Common DME Suppliers

Seniors who need durable medical supplies can get them from a variety of places, depending on details of what treatments they need, where they are performed and what kind of insurance coverage they have.

Hospitals usually have a large supply of durable medical equipment on hand. Crutches, prosthetics and various orthopedic devices are kept in large quantities in many medical centers, often as a convenience for people being discharged with ongoing mobility or therapy needs. If you have HMO coverage, your plan may cover some or all of the cost of these devices, while you might need pre-approval if the hospital you’re at is out of network.

Nursing homes provide many durable medical goods for residents, often free of charge. Sometimes these devices are included in the cost of nursing care, such as wander alarms and identity bracelets. Other medical devices used by nursing homes remain the facility’s property, though residents are free to use them, such as wheelchairs and shower chairs.

Private Purchase

Seniors with the insurance or personal funds to buy medical devices on their own can choose from hundreds of private DME providers. While some devices are usually only available with a prescription, such as eyeglasses, oxygen or dentures, many other items are available for purchase as with any other goods.

As a rule, insurers require pre-approval before paying for DME or for reimbursing the cost of a purchase. Details of private insurance plans vary, so it's generally a good idea to speak with a plan representative before making a purchase of durable medical equipment.

Medicare DME Coverage

Medicare is the federal health insurance program for adults aged 65 and over, or for younger individuals with a qualifying disability.

Some Medicare beneficiaries may need substantial support to remain healthy and safe, especially if they have limited mobility. As a result of this need, Medicare can often pay many of the costs seniors have when getting durable medical supplies.¹

Original Medicare coverage consists of two parts, Medicare Part A and Part B.

• Medicare Part B is optional Medicare coverage for outpatient medical care and supplies. Durable medical equipment most often covered by Part B.
  Part B beneficiaries can get help paying for mobility devices, from canes to motorized scooters, as well as medically necessary shoes, garments, testing supplies and home safety equipment, as long as they meet eligibility criteria and the DME is deemed medically necessary by their doctor.
  
  Part B can also help with a continuing supply of many disposable items, such as test strips and wound dressings.
  
  
• Medicare Part A is the inpatient hospital benefit that most beneficiaries get at no monthly cost. Part A does not directly pay for most DME, though anything given to a beneficiary in the hospital, as part of the inpatient treatment prescribed by a doctor, is likely to fall under Part A benefits.

Another part of Medicare coverage are privately-sold Medicare Part D prescription drug plans, which can assist with some DME directly related to prescribed medications. Some diabetes supplies and oxygen, for example, fall under Part D coverage, though many therapeutic items are covered under Part B.

Medicare Advantage (Part C) plans are sold by private insurance companies and cover everything that Part A and Part B cover, including durable medical equipment. Most Medicare Advantage plans also cover additional benefits not covered by Original Medicare (Parts A and B), such as prescription drug coverage, dental, hearing, vision, transportation and more.

You can compare Medicare Advantage and Medicare Part D plans online for free, with no obligation to enroll. Depending on where you live, you may be able to choose from a number of different plans that each cover DME and other medical supplies you need.

DME Coverage Under Medicaid

Medicaid is a program that offers basic health services for seniors and adults with limited incomes. As part of most states’ Medicaid coverage, medically necessary equipment, such as a hospital bed for the home or a wheelchair for people with limited mobility, may be covered.

Almost any DME that serves a medical purpose can be covered by Medicaid, but approval is usually contingent on a doctor’s recommendation and limited to the least expensive equipment and supplies that serve a purpose.