Durable Medical Equipment (DME) is any clinical equipment meant for usage in home. These medical apparatus provide the required support to disabled and otherwise challenged patients. Medicare DME benefits are available in accordance to Medicare regulations. Medicare is a federally administered social security and healthcare insurance system that ensures access to healthcare benefits including DME for United States permanent and legal citizens. People with certain disabilities or with advanced renal failure conditions can avail these benefits along with citizens and legal residents (above 65) needing special support and care as Medicare recipients. Whether or not you qualify for benefits are explained in your Medicare coverage documents and you should pay particular attention to each clause to know your eligibility.
Medicare system – Understanding the scope in the case of DME
Medicare system, as a whole, covers healthcare services (e.g. surgeries, doctor visits or lap tests) as well as supplies (mainly DME), both of which are considered highly essential for treating different medical conditions and diseases. The Medicare standards must be followed by all the private insurers. Medicare Part B is one of the four parts of the coverage scheme and it covers the following services and supplies:
• Medically Necessary Services (services and supplies needed to diagnose/treat a specific medical condition)
• Preventive Services (Necessary healthcare services to prevent illnesses such as flu)
One of the many services/supplies that come under the coverage is Medicare DME, a category that encompasses a number of equipment, including but not limited to blood glucose monitors, commode chairs, canes, home oxygen supplying equipment, crutches, infusion pumps, hospital beds, nebulizers, scooters, patient lifts, traction equipment, suction pumps, walkers, ventilators etc.
What are the basic eligibility criteria?
Your doctor is the only person to tell you whether you need a medical equipment of this type or not. You can only avail the Medicare (or any other equivalent insurance plan) if a qualified and licensed physician prescribes you a specific type of DME. To get the benefits, you must meet the following criteria:
• That the equipment will be used in your home
• That you are clinically proven to be ill or injured or paralyzed
• That you intend to use the appurtenance for only a medical reason
All US citizens who have Medicare can avail the benefits.
What are the costs?
If you have chosen the Medicare Part A and B the funded Medicare DME coverage, you will have to pay 20% of the approved amount. Both purchasing and rental of equipment are allowed. For availing the real benefits of ‘fee-for-service’ Medicare plans, you need to find a doctor/hospital that accepts Medicare. Fortunately, almost all doctor/healthcare facilities accept Medicare.
Do your homework first
If you have already started to consider different Medicare options, just put some more time in research. Whether you are opting for original (state funded and controlled) Medicare plans or you are buying the insurance plan through an authorized private insurer, there are cost differences that you should be aware of. You need to find a Medicare coverage plan that ensures your budgeted minimum out of pocket expenses.