Durable Medical Equipment
There are two primary types of medical equipment commonly used by seniors: durable medical equipment (DME) and disposable medical supplies. Both are designed to help elderly, disabled or ill persons manage their basic personal needs and daily care routines with greater ease. However, DME and disposable supplies cover an array of products that range in purpose and use, which will also determine whether or not associated expenses are covered by insurance and other programs. In short, durable medical equipment is any long-term reusable device that provides therapeutic benefits to patients due to a medical condition or illness. Disposable medical supplies such as gloves, injection needles, blood testing strips, catheters, incontinence products, etc., that are typically only used once and then disposed of.
What Qualifies as Durable Medical Equipment and When is it Covered?
As the name implies, durable medical equipment and supplies are designed to be used long-term as opposed to thrown away after use. In order to qualify under DME protocol items:
- Primarily serve a medical purpose
- Are prescribed or ordered by a medical provider
- Can be used again and again
- Are appropriate for home use
- Will not be useful to the patients without an injury or disability
When these conditions are met, many government and private medical benefit plans will cover part or all of the expenses associated with durable medical equipment.
The most commonly prescribed durable medical equipment for use outside of medical facilities include:
- Hospital beds, pressure mattresses, lift beds, bili lights and blankets
- Mobility aids such as walkers, scooters, canes, crutches and wheelchairs
- Personal care aids such as bath chairs, commodes, dressing aids
- Oxygen concentrators, monitors, ventilators and related supplies
- Traction equipment
- Kidney machines
Durable Medical Equipment and Services Excluded From Coverage
Clearly any items considered ‘disposable’ will not fall under DME categories, nor will upgrades or add-ons to equipment that are solely designed for aesthetic appeal or greater patient/caregiver convenience. Essentially, all upgrades must significantly enhance the equipment’s functionality and intended therapeutic purposes as required by the patient. This is why any and all DME devices and upgrades must be pre-approved and prescribed by a licensed provider, as coverage will likely be denied otherwise. While items such as humidifiers, air conditioners and stair chair lifts are durable, they are not generally considered primarily medical in nature, so coverage often doesn’t apply. Depending on the patient’s coverage and medical condition, certain costs associated with delivery and set up of durable medical supplies may fall partially or wholly upon the beneficiary.
How to Obtain Durable Medical Equipment and Supplies
The process of obtaining durable medical equipment will depend on the patient’s circumstances. For example, a senior being discharged from the hospital after an injury or surgery will usually work with a social worker or nurse who obtains the appropriate caregiver orders. Those being discharged from a rehabilitation facility may work with occupational and physical therapists who’ll help evaluate the patient’s home needs for medical supplies. Typically, a home care arrangement is certified through an agency and one of these care providers or a supervisory nurse arranges for ordering and for supplies to be delivered. Whether these supplies are to be purchased or rented short term will likely be determined by the recipient’s insurance coverage and their determination is based upon the client’s particular needs.
However, individuals can find themselves in need of durable and disposable medical equipment at any time in their lives, not just after surgery or an injury. The first step potential candidates for DME or disposable medical supplies should take is to seek guidance from their physician. They who can help clarify the patient’s need for the items and assist in determining what coverage options are available before writing prescriptions for durable medical supplies. Depending on the coverage provider, patients may be required to use specific approved vendors in order to qualify for partial or full reimbursements for equipment even in instances where those suppliers don’t offer the best price on what they need. As an example, Medicare has its own specific suppliers, which simplifies the claims process.
Patients have a wide variety of choices when choosing where to order disposable items because they typically aren’t covered by most plans. Some opt to order online or via catalog from medical supply companies while others can find many of these items locally at grocers, pharmacies or local medical supply stores. Those lacking adequate coverage often purchase durable medical supplies from these same sources.
Where Can I Find Durable Medical Equipment Near Me?
If you are looking for a durable medical equipment provider near you, try an online search. There are multiple providers across the nation that can assist you with finding the right equipment that you need to live a healthy and comfortable life. Remember to ask about costs and coverage when you visit a durable medical equipment provider to ensure that you are paying as little as possible out-of-pocket.
Options for Paying for Durable Medical Equipment
The primary methods seniors use to pay for expenses associated with medical supplies both durable and disposable are Medicare, Medicaid, Veteran’s Benefits, Private Insurance and Self-Pay.
- Medicare Coverage—Medicare Part A typically only covers about 80% of the costs associated with durable medical equipment as long as the supplies are deemed medically necessary and the patient also qualifies for the Home Health Benefit. Medicare typically doesn’t cover certain types of durable equipment such as hearing aids and adaptation items like bathroom grab bars and safety ramps, but this coverage varies by state. Disposable medical supplies are occasionally covered for items such as diabetic testing and administering supplies, feeding tubes and colostomy supplies.
- Medicaid Coverage—While this program is limited to those with limited incomes, it also covers a wider variety of durable medical supplies than Medicare. For example, Medicaid covers hearing aids and doesn’t have as strict limitations concerning the number of supplies and use duration that Medicare does. Furthermore, Medicaid tends to cover a larger portion of expenses, and often it covers all associated expenses for qualifying medical supplies.
- Veteran’s Benefits—The government program operated through the Veterans Administration is and excellent resource for obtaining essential medical supplies at low or no out of pocket cost.
- Private Insurance—Private insurers often cover a good portion of costs associated with prescribed durable medical equipment and may also cover some home safety modifications. However, they typically don’t cover disposable materials, but they might agree to partially cover some costs. It doesn’t hurt to inquire, as incontinence products alone can run between $200-300 monthly.