When you are taking care of a loved one with a serious medical condition or illness in the home, durable medical equipment (DME) can make it easier to provide him or her with the services that they need. From hospital beds to lifts and wheelchairs, DME includes a wide range of devices and equipment that are intended to provide therapeutic benefits to someone in need. If you are unfamiliar with durable medical equipment, the following is designed to provide you with all the information you need, including what DME is, how to get durable medical equipment, and how it is paid for.
What is Durable Medical Equipment
DME is defined as any medical equipment that can be used in the home to help provide a better quality of life for an individual who is seriously ill. (In some instances DME may be referred to as home medical equipment (HME) or home healthcare equipment.) To qualify as DME, the equipment must be durable, used in the home for a medical reason, and not typically useful to someone who is not sick or injured. Examples of DME include:
- Hospital beds, air fluidized beds/ mattresses that are used to minimize the causes of tissue breakdown, and traction equipment
- Manual wheelchairs, power mobility devices, canes, walkers, and crutches
- Commode chairs
- Oxygen equipment and accessories
- Nebulizers and associated equipment
- Tracheotomy equipment
- Ventilators and equipment
- Infusion pumps and supplies when needed to administer certain medications
- Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
- Continuous passive motion (CPM) machines
- Other devices depending on the medical condition
How Do You Qualify for DME?
First and foremost, a licensed physician/ provider must establish that there is a medical need for the equipment and the patient will benefit therapeutically from its use. He or she must write a prescription for the equipment. Depending on the item being prescribed, you may be able to use a Detailed Written Order (DWO) or a Certificate of Medical Necessity (CMN) as an alternative. A CMN is also needed when a person requires a specific brand or item model. This statement must describe the patient’s condition, as well as why the patient needs a certain item.
Certain medical supply companies are eligible to supply DME . To determine what companies in your area supply DME, access Medicare’s Find the Supplier website.
Who Pays for DME?
With the exception of oxygen, most DME can be purchased without a prescription. However, unless you have a prescription or written order for the item, you will most likely be responsible for the entire cost. In most cases, Medicare or other private health insurance will cover most of the cost, while the patient is responsible for the copayment. For example
- Medicare covers 80% of the cost of DME, with the patient responsible for the rest. However, Medicare caps rental equipment. They will pay for equipment rental for 13 continuous months (oxygen equipment rents for 36 months). After 13 months, the supplier must transfer the title to the beneficiary. This does not apply to oxygen equipment. Instead, the supplier must maintain the equipment for 60 months. After 60 months, the patient can opt for new equipment and begin a new 36 month rental period.
- In the event a Medicare patient is also a veteran, they may receive additional assistance. TRICARE for Life usually pays the 20% not covered by Medicare. CHAMPVA for Life (CFL) will also usually cover the Medicare copayment.
- Each state also provides some type of assistance to the disabled and elderly individuals who need DME and do not have insurance to pay for it. The Assistive Technology Projects can provide assistance in obtaining DME.
- Medicaid will usually pay for 100% of the cost.
- The amount covered by private insurance companies varies from one to the other.
If you or someone you know is in need of DME, please contact us and one of our durable medical equipment specialist will be happy to assist you in the process of receiving your durable medical equipment.