Medicare & Durable Medical Equipment

What is Durable Medical Equipment?

Durable Medical Equipment (DME) is equipment that assist users in activities of daily living, such as walkers, wheelchairs, hospital beds, etc. DME is necessary for the diagnosis or treatment of illness or injury to better the functioning, health, and safety of the user.

Medicare-covered DME meets these criteria:

  • Be “durable” and able to stand repeated use
  • Serve a medically necessary purpose
  • Be prescribed by your doctor
  • Used mostly within the home, or facility, and can also be used outside of the home
  • Last for three or more years

How does Medicare cover DME?

Medicare covers DME through two parts:

  • Part A: If you are in a skilled nursing facility or a hospital inpatient facility such as Queens Medical Center
  • Part B: If you are going to use the equipment within your home

What is the process of obtaining a DME?

To obtain a DME you must:

  1. Visit your doctor

    Schedule an appointment with your doctor or health care provider. Then visit your doctor and perform a face-to-face examination.

  2. Obtain a doctor prescription

    During your examination, your doctor must deem the usage of the equipment “medically necessary.” This office visit must take place no longer than six months before the prescription was written. Your doctor will fill the necessary documents verifying usage of equipment within your home, or facility, that the required office visit has occurred, and that the DME is medically necessary.

  3. Find a participating DME provider

    Upon finding a participating DME provider, you will need to give the documents your doctor filled out to the provider. The provider will then be able to complete your order.

What type of DME does Medicare cover?

Your Medicare-covered equipment should be the same regardless of being on Original Medicare or a Medicare Advantage Plan. Some examples of DME are:

  • Walkers, Canes, Crutches
  • Commodes, Urinals & Bedpans
  • Traction Equipment
  • Suction Pumps
  • CPAP
  • Patient Lifts
  • Oxygen Equipment and Accessories
  • Nebulizers
  • Manual Wheelchairs/ Power Mobility Devices
  • Infusion Pumps and Supplies
  • Hospital Beds
  • CPM machine
  • Diabetic Shoes & Inserts
  • Blood Sugar Test Strips
  • Blood Sugar Monitors
  • Air Fluidized Beds
  • Surgical Dressings
  • Enteral Equipment, Supplies & Nutrients
  • This and moreā€¦.

There are certain prescription medications and supplies that you must use along with your DME that Medicare also covers such as medication used with nebulizers. Another example are lancets and test strips used with diabetes self-testing equipment.

What type of DME does Medicare NOT cover?

Certain durable medical equipment is NOT covered by Medicare. These include:

  • Equipment intended to help you outside the home. For example, if you can walk short distances or enough to get around your home but would like a motorized scooters that you only need outside the home.
  • Supplies and items intended for convenience such as stairway elevators, air conditioners, bathtubs, etc.
  • Disposable supplies that get thrown away after short use such as catheters, surgical face masks, compression leggings, etc.
  • Items that are not used with equipment
  • Home modifications such as ramps or widened doors for improving wheelchair access
  • Equipment not suited for home use such as DME used in hospitals and skilled nursing facilities like paraffin bath units and oscillating beds.

NOTE: Medicaid/Med-Quest may cover some forms of equipment that Medicare will not.

To find out if Medicare covers the supply or item you need or to find a DME supplier in Hawaii, call our Hawaii SHIP Helpline at 808.586.1299 or contact us on this website and a trained volunteer counselor will get back with you shortly.

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This project was supported, in part by grant number 90SAPG0005, from the U.S. Administration for Community Living, Department of Health and Human Services. Grantees undertaking projects under government sponsorships are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

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