Navigating Medicare coverage isn’t always easy.
It can be challenging to understand the ins and outs, what’s covered, and what isn’t. There are differences in coverage depending on what exactly your loved one has. Because of this, it can be easy to overlook the benefits that your loved one is entitled to.
Here, we’ll explore Medicare Part A and B, and examine what types of durable medical equipment can be covered by your loved one’s plan.
Medicare has a variety of plans that cover different aspects of healthcare. This allows an individual the flexibility to choose which parts will be beneficial to them, and which are affordable for their situation.
Both Medicare Part A and Medicare Part B are insurance plans offered to any older adult over age 65 in the United States. Medicare Part A is also offered to any individual with specific disabilities, whereas Part B is strictly for older adults. Part A and Part B provide coverage for different areas of healthcare.
Medicare Part A covers inpatient medical care, meaning that a patient must be admitted to the hospital for Medicare Part A to be utilized.
Medicare Part A may also cover some skilled nursing facility care, surgeries, or hospice care provided the care recipient has been admitted to the hospital prior to receiving the service. Medicare Part A may cover some in-home care services if they are following hospitalization and only for a short period of time.
Medicare Part B covers outpatient healthcare services including doctor’s appointments, some preventative care, and durable medical equipment.
In this guide, we’ll be focusing on Medicare Part B. Keep in mind that your loved one may have coverage through other insurance companies as coinsurance which may have additional benefits. There is a part b deductible charged annually to the medicare beneficiary.
Other types of Medicare coverage include Part C and D which cover prescription drugs. These may also be referred to as Medicare Advantage Plans. Generally, after you have completed enrollment for a medicare program, you do not need to re-enroll annually.
Durable Medical Equipment or DME refers to products that are ordered or prescribed by a healthcare provider to address a medical need that can be used for an extended period of time.
Defined by the Centers for Medicare & Medicaid Services (CMS), types of equipment that are classified as DME and covered by Medicare Part B include:
These devices, along with others, are referred to as DME items and are covered by Medicare Part B when your loved one has a medical condition requiring the use of one or more of the aforementioned devices.
In many cases, this type of equipment can allow your loved one to spend more time aging in place, safely and improve their overall health outcome. Medicare covers these devices when they come from a DME supplier.
In some circumstances, you may be renting the equipment. If this is the case, there are often local centers for borrowing DME. In these circumstances, you may be responsible for paying out of pocket and then receiving reimbursement from Medicare. Other times, the healthcare provider prescribing the equipment will order it for you through a contract supplier.
Before making any purchases, it’s important to confirm that both the provider and supplier are covered by Medicare.
To confirm coverage, check out the Medicare website.
The cost of Durable Medical Equipment is set by DMEPOS (durable medical equipment and prosthetics, orthotics, and supplies) through the Competitive Bidding Program.
They will determine a medicare approved amount. If you need a device or brand of device that is not offered by a medicare supplier, your healthcare provider can provide documentation explaining the medical necessity for that specific device.
If you have questions regarding your loved one’s enrollment in their Medicare Plan, connect with your town’s senior center. Oftentimes, the senior center has volunteers available to provide support with navigating Medicare plans, options, and benefits.
With the costs of senior care rising, it’s important to fully understand your loved one’s insurance plan and what benefits they are entitled to.
Laurel McLaughlin has over a decade worth of experience in various sectors of the elder care field- home care, senior living, and non-profits. She has a Master’s in Gerontology and is a certified dementia practitioner.
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