Does Medicare Cover Adaptive Equipment Costs?

At Santé, one of our top priorities is to make life easier for our patients in post-acute care. This can include caring for who need adaptive or other equipment at home.

When prescribed such equipment, sometimes patients have questions about costs, particularly if they are on a fixed income. To help in this area, we have gathered pertinent information from Medicare to help guide our patients through the process. If you have Medicare and need equipment to help you get around and maintain your health and well being at home, here’s what you can expect.

Equipment must be medically necessary

In order for Medicare to cover what they call durable medical equipment, or DME, the equipment must be prescribed by a doctor and considered medically necessary. This means that your medical record must reflect disabilities, restrictions, or diagnoses that would warrant the use of medical equipment at home.

You must need the equipment at home

Patients who only need the equipment while in the hospital, in skilled nursing care, or outside the home will generally have to pay for their equipment out of pocket. However, patients who are covered by Medicare and who need the equipment in order to function at home (including in a long-term care facility that is their permanent home) are qualified for coverage under Medicare.

Equipment must be supplied by a Medicare-approved supplier

Once your doctor writes the prescription, he or she must send it to a Medicare-approved supplier in order for Medicare to cover their portion of the cost. It is a good idea to ask the supplier if they are approved prior to receiving your equipment.

You can get almost anything you need

Equipment covered by Medicare (when it meets the criteria discussed above) includes the following:

• air-fluidized beds
• canes
• blood sugar monitors and test strips
• patient lifts
• hospital beds
• commode chairs
• CPAPs
• CPM machines
• infusion pumps and supplies
• wheelchairs/power mobility devices
• suction pumps
• walkers
• crutches
• orthotics
• oxygen.

You’ll pay a small portion

Once you meet your Medicare Part B deductible for the year, they pay 80% of the cost of adaptive equipment you need at home. You’re responsible for the remaining 20%.

At Santé, we are happy to answer your questions about home medical equipment. Give us a call to learn more about how we can help you.