Medicare coverage is not always simple to navigate. It can be challenging to comprehend the ins and outs, and what needs to be covered. There are variations in coverage depending on precisely what your family member has. It is, therefore, simple to overlook the benefits to which your loved one is entitled.

Medicare offers numerous plans that cover various aspects of healthcare. This gives the individual the freedom to select the elements that will be most beneficial to them and are within their financial means. Medicare Part A and Medicare Part B are insurance plans available to all 65-plus-year-olds in the United States. Medicare Part A is also available to individuals with specific disabilities, whereas Medicare Part B is reserved exclusively for senior adults. Part A and Part B provide coverage for distinct medical services.

This article will assess Medicare Parts A and B (mainly) and the durable medical equipment covered by your loved one’s plan.

Part A Medicare

Medicare Part A provides hospitalization, so a patient must be admitted to the hospital to utilize Medicare Part A.

Medicare Part A may also cover skilled nursing facility care, surgical procedures, and palliative care if the patient is hospitalized before receiving the service. Medicare Part A may cover some in-home care services following a brief hospitalization, but only for a limited duration.

Part B Medicare

Medicare Part B covers ambulatory healthcare services, such as doctor’s visits, preventative care, and durable medical equipment.

This guide will concentrate on Medicare Part B. Consider that your loved one may have coinsurance coverage through other insurance companies, which may provide additional benefits. Medicare beneficiaries must pay an annual deductible for Part B.

Parts C and D, which cover prescription drugs, are other forms of Medicare coverage. These plans are also known as Medicare Advantage Plans. After completing enrollment in a Medicare program, you typically do not need to re-enroll annually.

What Is Durable Medical Equipment (DME)?

What is Durable Medical Equipment

Durable Medical Equipment, or DME, refers to medical products that can be used for an extended period and are ordered or prescribed by a healthcare provider.

The Centers for Medicare & Medicaid Services (CMS) classifies the following equipment as DME and as being covered by Medicare Part B:

  • Hospital Beds
  • Assistive devices such as canes, walkers, or wheelchairs (including manual wheelchairs and power wheelchairs, and scooters)
  • Diabetes care such as glucose (blood sugar) monitors and test strips
  • Oxygen equipment (may be required for people with COPD)
  • Commode chairs
  • Infusion pumps
  • Nebulizers
  • Orthotics
  • Prosthetics
  • CPAP (continuous positive airway pressure) machines

In numerous instances, such equipment enables your loved one to age in place safely, significantly enhancing their overall health outcome and affording them more quality time in their familiar surroundings. Medicare covers these devices when purchased from a DME provider.

Medicare Coverage of DME in Long-Term Care Facilities?

Medicare Part B covers medical supplies and equipment, also known as DME, prescribed by a physician or other health care professional. It is essential to observe that Part B covers household equipment and supplies.

What Qualifies as My “Home”?

A hospital or nursing home does not constitute a “home.” If care is received in a long-term care facility that does not predominantly provide skilled nursing or rehabilitation, the facility is considered a “home.”

Medicare Coverage Part B

Part B of Medicare will cover DME in a long-term care facility if a doctor or other healthcare provider prescribes the apparatus. The DME apparatus is then distributed by a Medicare-enrolled DME supplier.

What Does Part B Cover?

Medicare Part B covers:

  •   Certain doctor visits
  •   Medical equipment
  •   Medical supplies
  •   Outpatient care
  •   Preventive services
  •   Tests

Cooperating With a Medicare DME Provider

It must note that Medicare will only cover DME from a Medicare-approved and Medicare-supplier-numbered provider.

If you still need to determine whether a provider is Medicare-approved, ask the following questions.

  •   Are you enrolled as a Medicare provider?
  •   Are Medicare assignments accepted?
  •   Will you submit my Medicare claims?

Medicare will not pay for an item purchased from a department store or large chain if the supplier is not approved.

Where to Find DME for a Loved One

In certain situations, you may rent the equipment. If this is the case, there are frequently local centers where DME can be borrowed. In these situations, you may be required to pay out-of-pocket and then seek reimbursement from Medicare. The prescribing healthcare provider will occasionally acquire the equipment through a contract supplier.

Before making any purchases, confirming that the provider and the supplier are Medicare-covered is essential.

Does Your Loved One Need a Device Not Offered by a DME Supplier?

DMEPOS (durable medical equipment and prosthetics, orthotics, and supplies) determines the price of Durable Medical Equipment through the Competitive Bidding Program.

They will determine an amount approved by Medicare. If you require a device or brand of device that is not offered by a Medicare supplier, your healthcare provider can document the medical necessity for that device.

Still Uncertain Regarding DME & Medicare Coverage?

If you have queries about your loved one’s enrollment in Medicare, contact the TIB pharmacy. Frequently, the TIB pharmacy has volunteers who can assist with understanding Medicare plans, options, and benefits.

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