Dealing with Diabetes

Understanding Medicare Coverage For Durable Medical Equipment

Durable medical equipment refers to reusable medical equipment you use in your home to help improve the quality of your life. However, the medical equipment your doctor feels you need at home must meet certain criteria for Medicare to pay its portion of the costs. Therefore, it's important to understand Medicare's conditions and requirements before buying or renting handicapped equipment and supplies.

Documentation required for Medicare to pay for adaptive medical equipment:

  1. Your doctor must prescribe the equipment. He or she must provide you with a written statement to submit to Medicare explaining that you need the equipment because of a medical condition. The statement must be signed and dated. Some types of medical equipment require that your doctor complete and forward a Certificate of Medical Necessity to Medicare.

  2. The need for handicapped equipment should be clearly documented in your medical record. Detailed notes in your medical record provide evidence of how your medical condition significantly impairs your ability to function in daily life. When you schedule an appointment to see your doctor about a power wheelchair, he or she must write in your medical record that the reason for the visit was to examine you for the purpose of assessing your medical need for a power mobility device.

  3. When your doctor prescribes certain types of equipment, such as oxygen equipment, documentation must include proof of specific testing results.

  4. A Medicare-approved medical equipment supplier must receive an order for the equipment for Medicare to consider paying its 80 percent of the approved amount. You must order the equipment from a supplier that participates in the Medicare program.

Qualifications you must meet for Medicare to cover the cost of medical equipment and supplies for home use:

  1. You must have Medicare Part B coverage. Part B coverage includes medically-necessary doctor services (including preventive and diagnostic services and screenings), outpatient hospital care, outpatient therapies (such as physical and occupational therapies), some home health care services, and durable medical equipment.

  2. You must have a health condition or disability that requires help with activities of daily living.

  3. You must have a medical need for the equipment. Durable medical equipment and supplies are devices and items you can't use unless you are sick or disabled.

  4. You must use handicapped equipment inside your home. Medicare will consider covering a power wheelchair if you are physically unable to operate a manual wheelchair. However, Medicare won't pay if you only want to use the device to get around outside of your home.

  5. You must be able to use motorized mobility equipment safely. Medicare requires that you be able get on and off a power wheelchair and have the ability to operate it. If you aren't able to use the equipment on your own, you must have another person with you who can help.

What Medicare Won't Cover

Medicare Part B doesn't pay for the cost of making home modifications or installing permanent equipment to increase handicap accessibility. For example, Medicare may pay for a chair lift or bed lift in certain cases depending on your medical condition and if your doctor feels the equipment is medically necessary, but it won't cover a stair lift. It doesn't matter if your condition renders you unable to get up and down the stairs yourself. Medicare considers a stair lift a permanent fixture for which it won't pay.

While many types of adaptive equipment may make it easier for you to function, Medicare often doesn't consider their use medical in nature. Examples of non-covered equipment and supplies include wheelchair ramps, bathtub seats, raised toilet seats, incontinent pads, and grab bars. Contact a local equipment supplier, such as Alaska Mobility, with any questions.

About Me

Dealing with Diabetes

Growing up, I had a few close friends who I knew I could always depend on. One of these special people was diagnosed with type 1 diabetes when we were in high school. The shocking diagnoses was especially difficult for her to bear initially. However, she was blessed to have a good team of doctors and supportive family members and friends in her corner. Soon, she learned to manage her disease through the use of insulin shots. Nowadays, she thinks nothing about carrying around her cooler filled with life sustaining insulin shots. She also uses a portable device that monitors her insulin levels. On this blog, you will learn how to thrive after a diabetes diagnoses with the help of the right medical equipment and supplies.

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