Medicare Part B will cover DME that you need to and can use at your home providing your doctor decides it is medically necessary for you. The durable medical equipment must come with a prescription and qualifying documentation from a licensed, Medicare approved health professional to be covered. DME for use in a long-term care facility or a relative’s home can also be covered.
Then the equipment itself must qualify. To be covered by Part B, a DME device must be:
– Used due to a documented illness or injury – Used in a residential setting – Likely to last for at least three years – Is built for repeated use – Serves a medically necessary purpose (not just comfort or convenience)
There are many kinds of equipment and supplies that can be considered and covered as a DME. Some common examples are hospital-style beds, wheelchairs and oxygen equipment. However, the following items are some surprising not so well-known things that can be considered DME.
– Diabetic Test Strips: Part B pays for diabetes supplies such as test strips. You may qualify for as many as 300 test strips every three months if you need insulin. Patients not using insulin may be eligible for up to 100 test strips every three months. There may be limits on how many and how often you may get these supplies under your plan. Part B also covers supplies such as blood-sugar monitors and test strips. Other DME supplies like lancets, glucose control solutions, and devices also have coverage.
– Insulin Pumps: Patients with severe diabetes or Type 1 diabetes may need external insulin pumps. Medicare covers the pump and insulin when necessary.
Medicare can pay a portion of the cost of your diabetic shoes. Part B will cover both the fitting and the footwear. The Part B deductible still applies.
If qualified, Medicare will cover:
• One custom pair of molded shoes with inserts if you have either a severe diabetic foot condition or diabetes
• One pair of extra-depth shoes
• Two extra pairs of inserts each calendar year for your custom-molded shoes
• Three pairs of inserts each calendar year for extra-depth shoes
Also, Medicare can cover the cost of modifications to your shoes, rather than inserts. For Medicare to cover your diabetic shoe cost, your doctor must verify that the shoes are medically necessary for you.
Medicare usually won’t cover compression stockings since they aren’t considered DME. However, in the cases of certain specific diseases or conditions, Medicare may provide coverage for certain types of compression stockings.
The most common situation is where Part B will cover compression stockings if your doctor writes you a prescription to treat a venous stasis ulcer. Compression socks and stockings come in various sizes, lengths, and pressures. But Medicare only covers graduated compression stockings made to help issues below the knee, such as an open venous stasis ulcer.
The most common type of sleep apnea is obstructive sleep apnea. When someone has this condition, the soft tissue at the back of their throat collapses during sleep. This is often treated using continuous positive airway pressure, or CPAP, machines. Patients use these machines with breathing masks during their sleep. Medicare can help cover the cost of a medically necessary CPAP machine as DME. Additionally, the required supplies for a CPAP machine may be covered through Medicare. Keep in mind that the Medicare Part B deductible applies to all equipment.
An alternative treatment device for sleep apnea is the mandibular advancement device. This retainer-style medical oral appliance is one of the sleep apnea devices covered by Medicare if the device is deemed medically necessary.
Part B is from what is called original Medicare. However, there is now also a Part C called Medicare Advantage. This type of coverage requires enrollment and payment of an extra premium. When it comes to certain bathroom equipment such as a shower chair, handle grip bars and a raised toilet seat – Part B will usually not allow coverage for these items. However, many Medicare Advantage plans will cover these types of items.