May 23, 2011
Medicare Coverage of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
Durable medical equipment is any reusable medical equipment from wheelchairs and walkers to blood glucose monitors and ostomy bags. For beneficiaries with Medicare Part B, Medicare offers coverage on durable medical equipment as long as the equipment is durable or long lasting, medically necessary, and is prescribed by a doctor or treating practitioner to be used only in the home setting.
What is Covered?
Medicare can cover durable medical equipment, prosthetics, orthotic items, and corrective lenses. Below is a list of the types of equipment and devices covered by the Medicare program; this list does not include all equipment.
- Durable Medical Equipment
- Air fluidized beds
- Blood glucose monitors
- Canes
- Crutches
- Home oxygen equipment and supplies
- Hospital beds
- Patient lifts
- Scooters
- Ventilators or respiratory assist devices
- Walkers
- Wheelchairs
- Prosthetic and Orthotic Supplies
- Arm, leg, back, and neck brace
- Artificial limbs and eyes
- Breast prostheses
- Ostomy supplies
- Prosthetic devices for internal body part or function replacements
- Therapeutic shoes or inserts prescribed for those with diabetes
- Corrective/Prosthetic Lenses
- Cataract glasses
- Intraocular lenses
- Conventional glasses and contact lenses after surgery with an intraocular lens
Cost of Coverage
Typically, for durable medical equipment, prosthetics, and orthotic supplies, you pay 20% of the Medicare-approved amount for a piece of equipment after you pay your Medicare Part B yearly deductible. Medicare pays the other 80%.
For corrective lenses, Medicare covers one pair of eyeglasses or contact lenses after each cataract surgery with an intraocular lens. You will pay 20% after you pay your Medicare Part B deductible.
Individuals can either rent or own equipment depending on their needs. If you own Medicare-covered equipment, Medicare may cover repairs and replacement parts. If you rent, Medicare will make monthly premiums for the use of the equipment and any cost for repairs or replacements will be covered by the supplier.
Costs may differ on the type of equipment and/or if your supplier does not accept Medicare. There are requirements set in place for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers of equipment covered by Medicare. In making these requirements, Medicare aimed to ensure high quality products and services and to prevent fraud through requiring suppliers to be accredited and have surety bonds. Make sure your DMEPOS supplier is either enrolled in Medicare or is a "participating" supplier who accepts Medicare assignments; if a supplier does not fall into either category, Medicare will not pay your claim.
For individuals who receive Medicare Part A and Part B benefits through a privately insured Medicare Advantage plan, costs will vary depending on what plan you choose and may be lower than Original Medicare. If you are enrolled in a Medicare Advantage plan and need durable medical equipment, call your plan provider for cost and coverage information.
For additional information on Medicare-covered equipment and supplies in your area, call 1-800-MEDICARE (1-800-633-4227) for the direct number to your Durable Medical Equipment Regional Carrier. To find a qualified Medicare supplier in your area, visit Medicare's supplier directory.
