Durable medical equipment

What exactly is Durable medical equipment?

Durable medical equipment (DME) refers to medical supplies and equipment that a healthcare professional has ordered for a patient’s ongoing, regular usage. DME is the term for a wide range of medical equipment, such as nebulizers, CPAP/BiPAP machines, catheters, hospital beds, wheelchairs, and blood glucose monitors.

DME is cover by several insurance policies, including Medicare Part B. When used often at home and with a strictly medical purpose, a piece of equipment or a device must have a projected lifespan of around 3 years in order to qualify as DME under Medicare.

Bandages, face masks, and rubber gloves are examples of consumable medical items that are not regard as DME under Medicare.

Why is it crucial to have Durable medical equipment?

Patients with a severe medical condition, sickness, or accident can live at home with a greater quality of life thanks to durable medical equipment (DME).

DME may be prescribed by a healthcare professional to treat a patient’s chronic or life-limiting condition over the long term, such as a mechanical ventilator for a patient with advanced lung disease, or to accommodate a patient’s temporary disability, as in the case of a wheelchair or crutches for a recovering patient.

Medicare’s five requirements for durable medical equipment

• Medical need must be determined by a physician or other certified health care professional.
• Should last for at least three years in order to be useful.
• It must be strong enough to survive frequent use.
• Should not be beneficial to healthy or uninjured individuals
• Use this in your house only.

Medicare DME Coverage vs. Medicaid

The restriction on durable medical equipment and supplies used only at home does not apply if you are eligible for Medicaid.

Medicaid will pay for DME and supplies that you require to live and work outside of your home. If the supplies are require for you to function in your community and are not utilise in combination with a qualified DME, Medicaid will also cover them. Adult diapers and other disposable items may fall under this category.

You can be register in both Medicare and Medicaid at the same time, but you must fulfil Medicaid’s conditions for having a low income and limited financial means. Dual eligibility refers to when a person is eligible for both programmes.

The following are general descriptions of the supplies and equipment that Medicare does not cover:

• Particularly created tools or equipment to assist you outside of your house.
• Use of disposable materials with authorize durable medical equipment is prohibited.
• Your doctor or another trained health care provider may not consider certain equipment or gadgets to be medically necessary.
• Items that are primarily intend to increase your comfort or convenience.
• Things that should not be use in a house.

Examples of DME that Original Medicare Doesn’t Cover

• Cooling systems
• Chairs or lifts for bathtubs
• Catheters (may occasionally be cover as prosthetic devices if you have a lifelong condition necessitating them) (may sometimes be cover as prosthetic devices if you have a permanent condition requiring them)
• Tight-fitting leggings
• Using contacts
• Dentures
• Eyeglasses
• Grip handles
• Audio devices
• Absorbent pads
• Fluctuating beds
• Paraffin-fuelled baths
• Elevators on stairs
• Masks for surgery
• Commode seats
• Wheelchair access through enlarged doorways or ramps

Which Durable Medical Equipment (DME) Does Medicare Not Cover?

As long as the goods adhere to Medicare’s strict criteria of durable medical equipment (DME) and are medically require, DME and supplies are covered by the programme. Medicare does not pay for home modifications or durable medical equipment used outside the house.