When it comes to medical terms, it can be confusing to keep up with all the health care terms. As you age, there is one term that you will likely hear more than once – durable medical equipment or DME. While this may sound self explanatory, DME is a specific medical term used by insurance companies like Medicare and Medicaid. Let’s take a look at what durable medical equipment is and why you may need it at some point.
What Is Durable Medical Equipment (DME)?
Durable medical equipment (DME) refers to a specific medical term used by health insurance companies like Medicare, Medicaid, and private companies. DME is any medical device or supplies that are necessary for a person’s health, which can be used for a long-term basis. In general, seniors that have serious illnesses or mobility challenges need durable medical equipment more than other age groups.
To qualify as DME, the item must be:
- Used mainly for a medical purpose
- Ordered by a health provider
- Used for a long-term basis of at least a few years (not a single use item like a band aid)
- Used in the home
- Only used by patients that have an illness, injury, or disability
What Are Some Examples of Durable Medical Equipment?
Some common examples of durable medical equipment for home use includes:
- Bed equipment (i.e. bili lights or blankets, hospital beds, lift beds, or pressure mattresses)
- Mobility assistive equipment (i.e. canes, crutches, scooters, walkers, and wheelchairs)
- Kidney machines
- Oxygen concentrators, monitors, and ventilator supplies
- Personal care assistive equipment (i.e. shower chairs, commodes, and dressing aides)
- Traction equipment
What DME Is Covered by Medicare?
Medicare Part B covers durable medical equipment if your medical provider orders it for home use. This is great news for those that are currently enrolled in Medicare and need DME to continue living at home independently. When requesting DME, it’s vital to make sure that your medical doctor and supplier are both enrolled in Medicare. If your doctor and supplier are enrolled, your equipment will not be covered by Medicare, which can lead to an expensive medical bill.
Examples of DME Covered by Medicare Part B:
- Breathing equipment (i.e. CPAP devices, nebulizers and medications, and oxygen equipment and accessories)
- Commode chairs
- Continuous passive motion devices
- Diabetes supplies (i.e. blood sugar meters and test strips, lacets, and lancing devices)
- Hospital beds
- Infusion pumps and supplies
- Mobility assistive devices (i.e. canes, crutches, patient lifts, walkers, and wheelchairs)
- Pressure-reducing support surfaces
- Suction pumps
- Traction equipment
What DME Is Covered by Medicaid?
Like any government insurance, Medicaid programs and coverage vary by state. If you need DME, it’s recommended that you contact your local Medicaid office to determine what is covered. Medicaid typically covers medical equipment that is both affordable and medically necessary for a patient. Some state Medicaid programs cover all of the cost for durable medical equipment, while others only pay for a portion of it.
If you are enrolled in Medicaid, you may be wondering what the process looks like for requesting DME. While the qualification process varies by state, here is a basic idea of what to expect. You will first receive a letter from your doctor that lists what you need. Then, you will choose a supplier enrolled in Medicaid and take your letter to them. Your supplier will fill out a prior approval (PA) application and send it to your state Medicaid office, who will either approve or deny the request. Any approved request will allow the supplier to send you the DME and bill your insurance. For denied requests, you will be mailed a letter explaining the reason and information for how to appeal the decision.
Aside from government funded insurance, patients also have the option to use private insurance to receive their DME. In general, most private insurance companies will cover some or all of durable medical equipment costs. Other options include the VA for veterans, self-pay, and non-profit assistance from local organizations.
Source: Liberty Homecare
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