Durable medical equipment or DME falls under its own special category in insurance policies and Medicare benefits. More people are now "aging in place" or living at home instead of going to a facility when they age. As a result, approximately $100 billion dollars is spent on DME each year, with 15% of that amount being paid out-of-pocket. Each year, you may need additional medical devices to maintain your quality of life. At some point over the years, you or a loved one will undoubtedly need DME. Before you reach that point, check your policy to determine if you are adequately protected. You may also ask for information about pricing from your local medical supply store.
Durable medical equipment consists of many items. The most common DME items include:
- Bathtub seats
- Bed pans
- Bed rails
- Glucose monitors
- Stairwell elevators
- Hospital Beds
Hundreds of items are considered DME, and if you can prove a medical need for them, your insurance or Medicare should pay up.Those involved in determining whether these devices are necessary for you include doctors, nurses, physical therapists, and other caregivers. To receive coverage for DME, the patient often needs a prescription or a "justification statement."
Your insurance company probably covers some DME, but you need to check the terms of your policy. Some companies will charge you a copay for the equipment while others will apply it to your coinsurance, which means you may have a 20 - 30% coinsurance bill. Other policies have a yearly DME benefit limit, some as low as $2000. Getting good DME coverage should be a priority for you, particularly if you are disabled or a senior citizen not yet on Medicare.
Once you are eligible for Medicare, you will need to sign up for Part B to receive DME benefits. Under this plan, you will need to pay 20% of the cost of approved devices after you meet your deductible. However, those with a private supplemental Medicare plan will probably have to pay very little if anything for items determined to be medically necessary.
Healthy people often fail to check on DME benefits since they have had no need for these items. However, accidents, illness, and age can make durable medical equipment a necessity for receiving proper care in your own home. No matter what your age, make certain your current insurance policy covers these items. Paying out-of-pocket for them will be extremely expensive.