Medicare can provide coverage for your inpatient treatments, outpatient visits, and prescription medications. But one critical aspect of its coverage often goes overlooked – Durable Medical Equipment (DME). DME consists of medically necessary supplies that aid in injury prevention and recovery, respiration, maintaining healthy blood sugar levels, mobility, as well as hospital beds and commode chairs.
Medical supplies can be rented or purchased. Your provider may give you the option to decide between purchase and rental.
How Does Medicare Cover Medical Supplies?
Medicare Part B doesn’t just cover routine visits and screenings – it’s also responsible for medical supply coverage. You can get this during the Initial Enrollment Period (three months before you turn 65 up to the three months after the month of your 65th birthday) without paying a late enrollment fee.
Suppose you missed enrolling when you were first eligible during the Initial Enrollment Period. In that case, you can still enroll during the General Enrollment Period (January 1 – March 31), with coverage starting July 1. However, you may be subjected to a late enrollment penalty, which is why it is better to get Medicare Part B coverage sooner than later.
Medicare Part B’s role in this is reducing your coinsurance cost for your medical supplies after you meet your $203 deductible. Coinsurance is the percentage of the overall cost you’ll pay after Medicare has paid its share, which leaves you to cover 20% of the bill.
If your doctor is non-participating, then he or she can still agree to payment terms with Medicare. However, you will pay up to 15% more than you otherwise would have with a participating provider. This extra percentage is known as the excess charges.
Make sure that both your doctor and the medical equipment supplier accept Medicare. If they don’t, Medicare won’t cover you. You will pay the full cost for your medical supplies, which can be thousands of dollars.
You can get more than 20% off if you have a Medicare Supplement plan. However, you can only get it if you have Original Medicare, not Medicare Advantage. A Supplement plan can cut Original Medicare out-of-pocket costs such as outpatient coinsurance and copayment down to zero.
If you have Medicare Advantage, then this plan will provide the same coverage as Original Medicare (which includes Part B).
What Other Factors Can Influence How Much I Pay Out-Of-Pocket?
There is no set cost for how much you will pay for your medical supplies, even with medical professionals who accept Medicare.
Doctors charge different rates, regardless of whether they accept Medicare assignment. While you’ll only pay 20% out-of-pocket, there’s no guarantee of what that exact 20% will amount to. The type of facility and the company that supplies the medical equipment also influence your leftover expenses. This is why it is best to weigh ALL your coverage options.
What Medical Supplies For Injury Prevention And Recovery Does Medicare Cover?
Medicare Part B covers devices to keep you from getting hurt and optimizing recovery for current injuries.
In terms of injury prevention, you’ll get coverage for Pressure Reducing Support Surfaces to prevent ulcers from forming. You can also get patient lifts, which reduce your risk of injury from falling by safely transporting you from one area to another.
Continuous Passive Motion machines help with expediting healing and regaining mobility without requiring any exertion on your part. As for assisting in pain relief and treating misaligned bone structure, Medicare covers traction equipment, too.
In this way, Medicare gives you a cost-efficient path to safety and rehabilitation so that you stay away from injury and continue to do the activities you enjoy.
What Respiratory Devices Are Covered?
DME coverage extends to providing you with items so that you can breathe comfortably, as well as help you combat respiratory illnesses.
You can get coverage for devices that clear your airways and provide a consistent flow of oxygen into your lungs. Suction pumps, for example, will help remove fluids (e.g., mucus, saliva, and blood) and keep them from interfering with your breathing. Medicare also covers sleep apnea relief with Continuous Positive Airway Pressure (CPAP) devices, which facilitate oxygen delivery and promote restful, uninterrupted sleep.
Medicare Part B allows for reduced costs for nebulizer devices treating conditions such as cystic fibrosis, COPD, and asthma by directly delivering medication into your lungs. This provides instantaneous relief from your symptoms.
Does Medicare Cover Devices That Deliver Medications Into The Bloodstream?
Another form of medical equipment is the infusion pump. This allows you to get your medication delivered quickly into your bloodstream.
Medicare also provides coverage for home infusion services, where healthcare professionals educate you about how you can use your infusion pump safely and effectively at home.
What Blood Glucose Devices Does Medicare Cover?
Part B covers devices that help you monitor and stabilize your blood glucose levels. Blood glucose monitors, test strips, and lancet devices are all examples of what you can get for a fraction of the price. You can get coverage for insulin if an insulin pump is deemed medically necessary.
What Supplies Related To Mobility Does Medicare Cover?
Medically necessary equipment also encompasses items that assist you in walking. Crutches, walkers, wheelchairs, scooters, and canes are included here.
Get The Coverage You Need
Medical equipment is a must for many Medicare beneficiaries, and it isn’t unusual for this equipment to cost thousands of dollars. But with Medicare, you don’t have to sacrifice your financial freedom to get what you need.
At Medicare Peace of Mind, we equip you with the resources necessary to find you the coverage you need to cover your medical equipment needs. For more information about your Medicare options and what all will be covered, please call us today at 970-233-0063.
