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In addition to covering a wide range of services, Medicare also covers certain medical devices, items and supplies often referred to as durable medical equipment (DME).
The Centers for Medicare & Medicaid Services (CMS) defines durable medical equipment as special medical equipment, such as wheelchairs or hospital beds, that are prescribed by your medical provider for use in your home.
Use this guide to learn more about durable medical equipment, including a list of some of the DME that Medicare covers and the estimated costs you can expect to pay.
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Medicare covers a range of items, supplies and equipment such as durable medical equipment.
The list of DME that is covered by Medicare includes (but is not limited to):
The classification of DME extends to DMEPOS, or durable medical equipment, prosthetics, orthotics and supplies. Items in this classification include prosthetics such as artificial limbs or other body parts, along with things like braces and wound dressings.
In order for durable medical equipment to be covered by Medicare, the item in question must be:
Durable medical equipment is covered by Medicare Part B (medical insurance).
Once you meet your Part B deductible ($226 per year in 2023), you are typically required to pay a 20 percent coinsurance for the Medicare-approved cost for your qualified DME.
The following criteria must be met before Medicare will pay for your DME:
Depending on the type of durable medical equipment, you may have to purchase or rent the item.
Depending on where you live, the cost of your DME may be affected by the Competitive Bidding Program.
Under the program, DME suppliers submit a bid to Medicare to supply certain products to Medicare beneficiaries. Medicare then sets the amount it will pay for each item based on these bids.
Durable medical equipment can typically be obtained from three different types of providers, and each may carry a different cost for the same item.
Be sure to check with your doctor and your DME supplier to find out how much your equipment may cost.
You can enter your ZIP code and search the Medicare.gov Supplier Directory to find DME suppliers near you.
Medicare Supplement Insurance plans, or Medigap, provide coverage for many of the out-of-pocket costs that Medicare Part A and Part B don't cover.
Some Medigap plans can help cover some of the out-of-pocket costs associated with durable medical equipment.
DME costs that may be covered by certain Medigap plans can include:
Learn more about how Medicare Supplement Insurance can help cover durable medical equipment.
By law, Medicare Advantage plans are required to provide at least the same benefits as Medicare Part A and Part B (known together as Original Medicare).
This means that Medicare Advantage plans provide the same coverage for qualified DME as Original Medicare.
Medicare Advantage plans may also offer benefits not covered by Original Medicare that can help someone age in place at home.
Ask a licensed insurance agent what additional benefits may be covered by the plans you are considering.
Are you looking for Medicare coverage for your approved DME? Do you want to find a plan that may also cover additional medical equipment that isn’t covered by Original Medicare? You may be able to find a Medicare Advantage plan that offers the benefits you need.
Call to speak with a licensed insurance agent who can help you compare Medicare Advantage plans that are available where you live.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
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