When you or your loved one needs durable medical equipment (DME), there are several ways to go about getting it. The way that you may already know about is to go through Medicare. But Medicare rules are confusing! I’ve included many of them below for your information. Read on to learn 10 ways for older adults to get the equipment they need. Most of the ways do not include relying on Medicare.
The following info was gathered directly from the Medicare website. Per the website, Medicare Part B covers medically necessary durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:
- Durable (can withstand repeated use)
- Used for a medical reason
- Not usually useful to someone who isn’t sick or injured
- Used in your home
- Has an expected lifetime of at least 3 years
DME that Medicare covers includes, but isn’t limited to:
- Air-fluidized beds and other support surfaces (these supplies are only rented)
- Blood sugar monitors
- Blood sugar (glucose) test strips
- Canes (however, white canes for the blind aren’t covered)
- Commode chairs
- Continuous passive motion (CPM) machine
- Hospital beds
- Infusion pumps and supplies (when necessary to administer certain drugs)
- Manual wheelchairs and power mobility devices
- Nebulizers and nebulizer medications
- Oxygen equipment and accessories
- Patient lifts
- Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
- Suction pumps
- Traction equipment
For further information and many more details, visit www.medicare.gov
Problems you may encounter with Medicare
Note the DME coverage detailed above pertains to Medicare Part B (medical insurance) only. Medicare Part B is different than Medicare Part A which is hospital insurance. You typically do not pay a monthly premium for Medicare Part A if you are age 65 or older and you or your spouse paid in to Medicare taxes for at least 10 years. Medicare Part B is an add-on plan that has a monthly premium which is determined by your income.
When Medicare pays for DME, you may be subject to a copay as well as your Medicare part B deductible. You will often be required to have a face to face visit with the doctor as well. There are very strict rules about what makes a person eligible for coverage of each of these devices as well as how often Medicare will pay for them. It is very difficult to qualify for a hospital bed, for example.
There are many reasons that you may choose not to go through Medicare for the DME that you need. I’ve listed some of the more common reasons below
- You simply don’t want to go through all the “red tape.” Some of this red tape includes getting all the proper forms filled out, having a face to face appointment with the doctor, etc.
- You need 2 pieces of equipment when Medicare will only pay for 1. For example: you’d like to have a walker to keep on the main floor of your home as well as one in the basement so you don’t have to lug it up and down the stairs when you already have mobility limitations.
- You want a wheelchair or scooter for maneuvering in the community even though you don’t technically qualify for one based on Medicare guidelines.
- Medicare already bought you a wheelchair, but now you’re getting better and you want a walker which Medicare will not cover.
- Medicare denied your claim.
- You don’t have Medicare Part B.
- You don’t have time to wait for the equipment you need.
- Medicare doesn’t pay for the type of equipment that you need. Shower chairs, adult diapers, reaching tools, and tools that assist with dressing are examples of items that Medicare does not pay for.
So what are your options?
Here are 10 ways for older adults to get the equipment they need:
- Use your Medicare Part B benefits. (Or use VA benefits if you’re a veteran. The whole process is a little simpler with the VA than with Medicare.)
- Purchase directly from a DME company. When hospitals assist you with getting the equipment you need through Medicare, they often go through DME companies. You can purchase directly from the DME company without using insurance benefits, but they generally have inflated prices due to the fact that they typically bill Medicare rather than individuals. On the plus side though, DME companies often deliver the equipment directly to you. Even if you’re still at the hospital. Sometimes this benefit is worth it if you need the equipment immediately.
- You can purchase many of your basic equipment needs at retail pharmacies such as Wal-Mart or Walgreens. If they don’t have what you need in the store, they may have it online. You can then have it delivered to your home or to your local store. One of the best things about purchasing from a local retail store is that you can typically return the product pretty simply if you end up not needing it or not liking it.
- Amazon.com is an option for most equipment that you may need. Their website will allow you to compare prices and read reviews from other purchasers as well. Plus, they deliver to your door.
- Craig’s List is an option, but check prices closely. Often their used equipment prices are higher than they should be. If you find something on Craig’s List, be sure to compare the asking price to the price of new products online to ensure that you’re not paying too much. Barter for a better price if needed.
- Churches often have donated equipment that they loan out or give away to people in need in their communities.
- Check out garage sales and estate sales.
- Borrow from a friend, neighbor, or family member if you don’t anticipate needing the equipment for very long.
- Visit the website for the Pass It On Center and search based on your state. Their website says “The pass it on center continues to create national and state resources to foster the safe, effective, and appropriate reuse of assistive technology (AT) so that people with disabilities can get the affordable AT they need in order to live, learn, work, and play more independently in communities of their choice.” They don’t just service older adults, rather they offer support to people with disabilities of all ages. And the types of equipment that they can help with include devices for vision, hearing, speech, mobility, daily aid, environmental, vehicle modifications, computer, recreation, and cell phones.
- Check the internet for local programs and resources that might be able assist with your needs. There are likely local programs at your disposal that the Pass It On Center does not include.
As you can see, there are many ways to get the equipment that you need to make your life safer and simpler. Don’t just give up if Medicare denied your claim or if you can’t afford the equipment you need. On the other hand, if you have equipment that you are no longer using, consider donating it so another person in need can have a better quality of life. Lastly, check the Advocating for the Aging facebook page where donated items are often posted.