Medical Equipment Suppliers and Medicare
Medical equipment and supplies cover a vast range of tools and products for hospitals, health-care facilities, and homes. This includes, but is not limited to, monitoring systems, glucose meters, pumps, thermometers, syringes, blood processing devices, specialty bags, wound care, wheelchairs (electric, lightweight or standard), commodes, walkers, mobility ramps, bath benches, along with such medical supplies as catheters, adult diapers, and latex gloves.
Not all of the above-mentioned items are covered by Medicare. However, Medicare may cover the cost of medical equipment and supplies that meet certain requirements. Learn more about what types of medical equipment are covered, your costs as a beneficiary, and how to find a Medicare-approved supplier.
Medicare coverage for medical equipment and supplies
Medicare will cover certain types of medical equipment. In order to be covered by Medicare, medical equipment must be:
- Able to withstand repeated use.
- Primarily and customarily used to serve a medical purpose.
- Generally not useful for people without an illness or injury.
- Appropriate for use in the home.
- Likely to last for three years or more.
- Provided by specific suppliers that are approved by Medicare.
- Medically necessary for you.
Some examples of this equipment are walkers, wheelchairs, power scooters, hospital beds, home oxygen equipment, diabetes self-testing equipment (and supplies), certain nebulizer, and their medications (non-disposable). Additional rules apply for Medicare coverage of wheelchairs and scooters.
Medicare also covers prosthetics, orthotics and certain supplies. Prosthetics are devices that can replace a missing body part, such as a hand or leg. Orthotics may include braces that help to support or correct the malfunction of a limb or torso.
What’s not covered by Medicare?
In most cases, Medicare does not cover medical supplies, like catheters, that are generally used and thrown away. However, Medicare will cover certain medical supplies, like lancets and test strips for diabetes. Some diabetes supplies are also covered under Medicare Part D. Furthermore, if you qualify for Medicare home health care, Medicare may cover certain disposable supplies, such as intravenous supplies, gauze or catheters.
Your costs for medical equipment and supplies
How much you pay for medical equipment and supplies depends on whether you have Medicare Part B coverage and where you buy your equipment. In general, if you are enrolled in Medicare Part B, you will pay 20 percent of the approved Medicare amount after you have met your yearly deductible (if you do not have secondary insurance). You may receive additional coverage if you are enrolled in a Medicare Advantage plan. Review all the factors that affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you buy your equipment through a Medicare-approved supplier that “accepts assignment,” meaning they agree to accept no more than the Medicare-approved amount for a service.
How to choose your medical equipment supplier
You will save money if you order your items from a Medicare-approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your equipment from any store that sells it. However, if the supplier from which you order is not approved by Medicare, Medicare will not pay for the durable medical equipment.
There are two types of Medicare suppliers: Participating suppliers and those who are approved, but have chosen not to participate. A Medicare-approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the approved rate. They may also ask you to pay the entire bill when you pick up your order. In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait, as it may take a couple months to receive payment. If you receive your Medicare coverage through a Medicare Advantage plan (HMO or PPO), it is likely that the plan will have its own rules for equipment purchases. For more information about your Medicare plan options, contact an eHealth licensed insurance agent today.