What Durable Medical Equipment Will be Covered by Medicare

Medicare’s Complex Design

Sixty-five years ago, Medicare began with a signing ceremony by President Johnson. Decades later, and with multiple expansions, the Medicare program of the 21st Century is highly complex and confusing. “Open Enrollment” is now underway for all the approximately forty million Americans covered by the program.

I have written this roadmap to Medicare to help you navigate this selection journey. This is no easy decision to make. In fact, if you fail to make a selection, one will be made for you. You may not be happy with your assigned provider. I encourage you to spend the time making a careful intentional choice for your healthcare benefits.

Medicare Options

Part A – Acute care in hospitals for a shared room, meal, and nursing care. In some plans, it also covers home health care, nursing home stays, and hospice care.

Part B – Covers the care you receive outside the hospital or nursing home stays. This pays for outpatient and therapy care, doctor’s visits, prevention care like vaccinations and DME. Wheelchairs & scooters

Part C – Commonly known as Medicare Advantage. These plans are purchased through insurance companies. They cover the items listed here for Parts A & B and Part D. Each Medicare Advantage plan sets up their benefits profile and cost paid by members depending on the local market where they are selling the plans. Some of these plans now offer vision, hearing, and dental coverage (which regular Medicare does not). Medicare Advantage covers DME like Medicare Part B and sometimes beyond. Medicare Advantage plans offer benefits to address social needs as well as medical.

Part D – Prescription drug benefit and the most recent addition to Medicare coverage. Part D coverage is sold by insurance companies and varies in what prescription is covered (name brand and/or generic).

Medicare supplement – Also known as Medigap, there are many varieties of supplement plans that pay the co-pays, deductibles and extend the benefits offered in Medicare Parts A & B. There are many varieties when it comes to Medicare Supplement plans, choose carefully.

Medicare Open Enrollment is NOW

Selecting the Right Medicare Plan for Durable Medical Equipment

Durable medical equipment is typically thought of as the big-ticket items such as wheelchairs, hospital beds, electronic, and manual lifts and the list goes on that Medicare purchases or rents on behalf of the patient. However, Medicare covers many other items that are not these big ticket items as well. Additionally, the expansion and variability of Medicare Advantage plans are addressing the Social Determinants of Health with money for home renovations and repairs, food, housing, transportation, caregiver services, and technologies that are beyond the world of DME.

Healthcare has been transformed by the rapidly changing furniture, devices, and gadgets we know as Durable Medical Equipment (DME). Today it is possible to set up an entire hospital room at home thus reducing the anxiety of illness and recovery in unfamiliar surroundings.

DME categories

· Mobility – walkers, canes, crutches, knee walkers, rollators and mobility accessories

· Bath Safety – bath benches, bath accessories, transfer benches, elevated toilet seats, grab bars, safe-t-poles, and commodes

· Wheelchairs – narrow, basic, extra-wide, antimicrobial, bariatric, pediatric, recliner, hybrid, translator, transport, and cushions and accessories

· Hospital Beds – basic, simplicity, bariatric, bed accessories, mattresses, side rails, trapeze bars, and over bed tables

· Patient Handling – bath lift, stand assists, floor lifts, slings, solo lifts and solo vests, gait pacers, patient safety devices, transfer board, transfer sheets, and stretchers

· Patient Safety Alarms – pressure-sensing safety, pull cords, wireless, voice recordable and specialty alarms

· Therapy – Resistive exercise, Tens units, pain relief, exercise balls and mats, exercisers, instant packs, ice bags, activities of daily living products. and tools

How to Select the Right DME

Have you ever bought a car or a truck? How did you feel when you were negotiating? Unless your last name is Ford, you probably didn’t discuss how a car is made at the dinner table. The same goes for durable medical equipment purchasing. Your ability to choose the right equipment is dependent on your knowledge and familiarity with these products.

New equipment is most likely needed after a significant event such as a broken bone, car accident, medical crisis, or illness. Therefore, your DME decisions will be guided by the care team working with you at the time. Rehabilitation therapists (physical, occupational, speech, respiratory, and recreational to name a few) will likely introduce the equipment you will use at home during your hospital stay. Additionally, the discharge planners, social workers, and nurse educators also provide training and education to make sure the patient and family members can carry on with the right practices to continue recovery at home. Lastly, the home-based services and your primary care providers take over managing your recovery and DME use until it is no longer required.

Who Will Operate the DME?

We strongly advocate that a home visit by a therapist be conducted BEFORE hospital discharge and/or ordering the DME.

1. Who will use the equipment (how many people needed to operate it?)

2. What skills will be needed to operate the equipment?

3. Will it fit in your home? What are the options?

4. How long will this equipment be useful? What happens if physical or mental decline renders it useless?

5. Is the selection customized to the person? Is it sized right? What special features will make it right for you?

6. Who will assemble the equipment?

CreditForCaring Resource Directory

Your Medicare plan enrollment is not an easy task but necessary for maximizing your insurance coverage and limiting out of pocket expenses. Our team knows how difficult it is to navigate this government system. We have built a free Resource Directory to help you with your insurance selection and the entire world of long-term care. Try out The Advanced Resource Finder to see what we built for you.

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