Medicare Coverage for Durable Medical Equipment (DME):
What You Need to Know

Understanding Medicare Coverage for DME

Medicare Part B covers durable medical equipment (DME) when it is prescribed by a doctor and meets specific criteria. Because these rules can feel confusing, understanding them early can help you navigate the approval process and ensure you receive the equipment you need.

What Qualifies as Durable Medical Equipment?

Medicare defines DME as equipment that:

• Can withstand repeated use
• Is primarily used for medical purposes
• Is not useful to someone without an illness or injury
• Is appropriate for use in the home

Commonly Covered DME Items

• CPAP machines and supplies
• Oxygen equipment
• Wheelchairs and scooters
• Hospital beds
• Walkers and canes
• Blood glucose monitors
• Nebulizers

Medicare Coverage Requirements

To qualify for Medicare DME coverage, you must meet these requirements:

1. Medicare Enrollment

You must be enrolled in Medicare Part B, which includes outpatient services and DME coverage.

2. Doctor’s Prescription

A Medicare-enrolled doctor must prescribe the equipment and confirm that it is medically necessary for your condition.

3. Supplier Requirements

You must obtain equipment from a Medicare-approved supplier. Border DME is fully approved, which ensures that all equipment meets Medicare’s strict coverage standards.

The Approval Process

The steps for DME approval usually include the following:

Step 1: Medical Documentation

Your doctor must provide detailed medical records that explain your diagnosis, why the equipment is necessary, how it will help your condition, and why less expensive alternatives will not work. This information helps Medicare confirm medical necessity.

Step 2: Prior Authorization

Some equipment requires prior authorization. Therefore, our team submits all paperwork for you to ensure the process moves smoothly.

Step 3: Delivery and Setup

Once Medicare approves your equipment, we deliver and set it up. Additionally, we provide training on how to use and maintain it properly.

Understanding Your Costs

After meeting your Part B deductible, Medicare typically covers 80% of the approved amount. You are responsible for the remaining 20% coinsurance. If you choose a non-participating supplier, you may pay more.

Rental vs. Purchase

Medicare has specific guidelines for renting and purchasing equipment:

• Rental Items: CPAP machines, oxygen equipment, and hospital beds are usually rented for 13 months. After this period, you generally own the equipment.
• Purchase Items: Walkers, wheelchairs, canes, and blood glucose monitors are typically purchased outright.

Replacement and Repair Coverage

Medicare covers replacement when the equipment is lost, stolen, damaged beyond repair, or reaches the end of its useful lifetime. Repairs are also covered when they are more cost-effective than replacement.

Tips for Maximizing Your Benefits

To make the most of your Medicare DME coverage, consider the following tips:

1. Work With Medicare-Approved Suppliers

Always choose a Medicare-approved supplier like Border DME to avoid unexpected costs and ensure full coverage.

2. Keep Detailed Records

Maintain copies of prescriptions, medical records, and all communication with Medicare to support approvals and appeals.

3. Understand Your Coverage

Review your Medicare Summary Notice (MSN) regularly to understand what Medicare covered and what amount you owe.

4. Appeal if Necessary

If Medicare denies your request, you have the right to appeal. Our team can assist with documentation and the appeal process.

How Border DME Helps

Navigating Medicare can feel overwhelming. Our experienced team makes the process easier by handling paperwork, verifying coverage, managing authorizations, resolving issues with Medicare, and providing ongoing support for maintenance and replacements.

Contact us today to learn how we can help you maximize your Medicare DME benefits.