Durable medical equipment (DME)
Coverage
Durable medical equipment (DME) is equipment that helps you live better and go about your normal activities at home. DME must meet the following criteria: it must be able to withstand extended use, must be used for a medical reason, must not be useful to someone who is in good health, must be used in your home, and must have a lifetime of at least 3 years.
Part A covers medical equipment for individuals who are in a skilled nursing facility or in the hospital. If the equipment is medically necessary and purchased from an approved supplier, Medicare Part A will pay 80 percent of the allowable amount for any specific item. The individual or their supplemental insurance is responsible for paying for the remaining 20 percent and any amount over the allowable limit.
Part B pays for medical equipment to be used in your home for most Medicare recipients, even if they are not confined to their home. A nursing home does not qualify as a “home”. Home medical equipment must be medically necessary, prescribed by your physician, and purchased from a Medicare-approved supplier. Medicare Part B pays for 80 percent of the allowable purchase price. The individual or their supplemental insurance is responsible for the remaining 20 percent and any amount over the allowable limit.
Part C, also known as Medicare Advantage, is required by law to provide, at a minimum, the same coverage as Part A and Part B. Therefore, if you have Medicare Part C, your plan will pay at least 80 percent of the allowable limit for durable medical equipment.
Costs
The cost of your particular device will vary based on your supplier and what device it is. Make sure that your supplier is Medicare-approved.
What to Know
Beware of scams when choosing durable medical equipment. Only go through a Medicare-approved supplier, and do not fall for people calling to offer you free equipment.
