Health-care facilities, homes, and hospitals use medical equipment suppliers to cover their products. The following is a list of tools that they cover which includes, but is not limited to:
- Bath benches
- Mobility ramps
- Monitoring systems
- Glucose meters
- Walkers
- Commodes
- Pumps
- Thermometers
- Wheelchairs (electric, lightweight or standard)
- Wound care
- Syringes
- Specialty bags
- Blood processing devices
- Along with other medical supplies like latex gloves, catheters, and adult diapers.
Medicare does not cover all of the above-mentioned items. Yet, they still may pay for medical supplies and equipment that satisfy certain conditions. Read on to see the Medicare coverage for medical equipment, how to find a supplier that Medicare approves, and the costs you will owe.
What does Medicare cover for medical supplies and equipment?
Various types of medical equipment will have Medicare coverage. Below are the requirements that medical equipment must have in order for Medicare to cover it:
- It is a necessity for you.
- Provided by certain suppliers that are Medicare-approved.
- Suitable for use in the home.
- Likely to last for at least 3 years or more.
- Typically people without an injury or illness do not need it.
- Serves a medical purpose.
- Able to endure repeated use.
The following are some examples of this equipment:
- Diabetes self-testing equipment (and supplies)
- Non-disposable medications
- Specific nebulizer
- Home oxygen equipment
- Walkers
- Hospital beds
- Wheelchairs
- Power scooters
The Medicare coverage will also pay for orthotics, prosthetics, and certain supplies. Orthotics are devices like braces that will assist to correct or support a limb or torso injury. Prosthetics are devices that can replace a missing body part, like a foot or arm.
What are the Medical Supplies and Equipment Not Covered By Medicare?
For most instances, medical supplies like catheters which are usually used then thrown away are not covered by Medicare. However, specific medical supplies like test strips and lancets for diabetes are covered by Medicare. Medicare Part D (prescription drugs) also covers diabetes supplies. Medicare may cover certain disposable supplies if you are eligible for Medicare home health care. Below are examples of what they may cover, but not limited to:
- Gauze
- Catheters
- Intravenous supplies
Your expenses for medical supplies and equipment
What determines the amount you owe for medical supplies and equipment? Where you purchase your equipment and whether you have Medicare Part B or not will determine the costs you will have to pay. Typically, as a Medicare Part B enrollee, you will owe 20% of the Medicare-approved amount after paying your yearly deductible. If you have secondary insurance, you may not have to meet the yearly deductible. If you are a Medicare Advantage plan enrollee, you get additional coverage. If you want to know how much Medicare coverage you’ll get, read over your plan details. Please note that you want to purchase medical equipment from a supplier that Medicare approves. The supplier should ideally “accepts assignment.” This means that the supplier agrees to accept no more than the amount that Medicare approves for a service.
The guide to choose your medical equipment supplier
If you want to save money, purchase your equipment from providers that Medicare approves. There are strict requirements if a supplier wants to qualify as a Medicare supplier plus they will have a Medicare supplier number. You can choose to purchase your equipment from anywhere that sells what you need. However, be aware that Medicare will not cover the durable medical equipment from anywhere. They will only cover equipment from certain suppliers that Medicare approves.
Below are the two types of Medicare suppliers:
- Participating suppliers
- Suppliers that Medicare approves but choose not to participate.
A provider that Medicare approves but does not choose to participate can charge more than the amount that Medicare approves. However, there is a limit on how much they can charge. They can charge a maximum of 15% above the rate that Medicare approves. When you receive your order, they can also request that you pay the whole invoice. For this condition, you will get a direct reimbursement from Medicare. But please note that you may have to wait a couple months to get the payment. Plans will generally have their own rules if you want to purchase equipment, especially coverage through a Medicare Advantage plan (PPO or HMO). Contact one of our insurance agents today if you want more information about your Medicare plan options.