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Does Medicare cover durable medical equipment (DME)?

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[x_blockquote cite=”Gabrielle (Bardstown, KY)” type=”left”]Dear Marci,
My doctor recommended that I get a manual wheelchair to get around my home. Does Medicare cover wheelchairs? If so, what do I need to do so that they will cover it?[/x_blockquote]

Dear Gabrielle,

Yes, Medicare covers wheelchairs. Wheelchairs, and other items such as walkers and oxygen equipment, are known as durable medical equipment (DME). If you have Original Medicare, DME is covered by Part B (medical insurance). If you have a Medicare Advantage Plan, it covers everything that Original Medicare covers, but may have different costs and rules.

Medicare covers durable medical equipment that is:

  • Durable, meaning you can use it again
  • Designed to help your medical condition or injury
  • Meant for use in your home, although you can use it outside the home
  • Likely to last for three years or more

There are a few steps to follow to get Medicare to cover your DME. First, your doctor must prescribe the equipment and certify that you will need to use the equipment in your home.

Next, you should get your DME from an appropriate supplier. For Original Medicare, this depends on where you live. If you live in a region that is part of the competitive bidding demonstration, you will have to get your DME from a supplier that participates in the program. If you live in a region that is not part of the demonstration, you must get your DME through a supplier that has approval from Medicare. You can find a Medicare-approved supplier by visiting www.medicare.gov/supplier. If you have a Medicare Advantage Plan, you should contact your plan to find a certified supplier.

You will usually rent your equipment from a supplier. For Original Medicare, you pay 20 percent of the cost of the rental fee for 13 months, and then you are usually given ownership. If you are paying a monthly rental fee for your equipment, your supplier must perform all needed repairs and maintenance requiring the work of a professional—without charging you extra. If you own your equipment, Original Medicare will pay 80 percent of the Medicare-approved amount for repairs and maintenance, and you will be responsible for the 20 percent balance. If you have a Medicare Advantage Plan, you may pay a fixed rate or a coinsurance to rent or buy your DME. You can contact your Medicare Advantage Plan to learn about costs and coverage of DME.

Overall, it is important to follow either Original Medicare or your Medicare Advantage Plan’s rules to get your DME covered.

– Marci

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