Home Medical Equipment Covered by Medicare
Don has painstakingly saved almost $15,000 to cover the anticipated cost of buying medical equipment for his wife to use when he brings her home from an in-patient rehabilitation stay. He called us this week looking for information about where he could get the best deals on a hospital bed, a wheelchair and the other equipment she will need.
Don's wife has multiple sclerosis. Her needs for equipment are great, and she will need more assistance in the future. Don was smart to go looking for information before he bought, because Medicare does cover the cost of much of the equipment that his wife will need. Medicare won't cover everything, however, and he will need some of that money to purchase what they will have to cover themselves. Had he gone out and bought things that are covered, he would have much less available to use for other necessary items.
Before you decide to purchase any medical equipment for your senior, be sure to inquire whether it would be covered by Medicare. Not all suppliers participate in Medicare. Durable medical equipment suppliers who do work with Medicare will have this information at their fingertips if your doctor doesn't.
What Equipment Does Medicare Routinely Cover?
While Medicare will cover 80% of the cost of home medical equipment if a doctor determines it is necessary, their definition of "medical" is sometimes peculiar. While by no means exhaustive, here is a list of the items most often used by patients at home that Medicare will cover:
For a patient who needs to be positioned in bed, or who needs to be able to easily transfer from bed to chair, a hospital bed for home will usually be covered with a doctor's order. Medicare will cover 80% of the cost of a manual or a semi-automatic electric bed. While Medicare will not cover the cost of a fully-automatic bed (such as they use in hospitals), the patient can often make arrangements to pay the difference.
Hospital Bed Mattresses
Medicare will generally only cover the cost of a plain, flat mattress. If the patient has pressure ulcers (bed sores), Medicare will cover special mattresses designed to help heal these ulcers. Unfortunately, once the sores are healed, Medicare will not cover the cost of these special mattresses for prevention.
Mobility Aids: Canes, Walkers, Crutches, Wheelchairs
Canes, standard walkers, rolling walkers, crutches and manual wheelchairs are covered with a simple prescription, or "order" from the patient's doctor. One thing to keep in mind is that Medicare will not supply an individual patient all of these items. If a patient is able to get around with a cane, Medicare will not cover the cost of a wheelchair unless the patient's needs have increased. If a patient has a Medicare-covered wheelchair, then Medicare will not cover the cost of a cane or a walker.
Medicare will usually cover a manual wheelchair with little problem. Motorized wheelchairs and scooters require considerably more paperwork from the doctor and specific medical conditions that make using a manual wheelchair impossible.
If a patient is unable to stand or to bear any weight on his or her legs, with the appropriate documentation from the doctor Medicare will cover 80% of the cost of special lifts so that the patient can safely be transferred out of bed. To use these lifts safely caregivers should receive some training, so be sure you have instruction before you try to use a patient lift.
If the patient needs supplemental oxygen to achieve sufficient oxygen levels in the blood Medicare will cover 80% of the cost of an oxygen concentrator and supplemental oxygen cannisters for use during power or machine failures and when leaving home.
If a patient cannot stand up independently from a chair, but can walk once safely standing, Medicare will cover 80% of the cost of the motor in a recliner that will lift the patient. They will not cover any of the cost of the chair itself, however. As the motor is only a small part of the total cost of a lift chair, the patient will have to bear most of the cost.
Bathroom Safety Equipment:
Surprisingly, as so many accidents happen in bathrooms, Medicare will not cover the cost of any bathroom safety equipment. The patient will have to pay privately for safety grab bars, shower benches or shower stools, raised commode seats, and any other equipment used in the bathroom.
The only exception to this rule is that they will cover 80% of the cost of a bedside commode if the patient has difficulty reaching the bathroom and needs a commode in the bedroom. Also known as a "three-in-one" commode, the bedside commode can be placed over the toilet to provide arms and an elevated seat, and can be placed in most tubs or shower stalls to function as a bath seat.
This summary is by no means a guarantee that Medicare will cover the equipment you need. The rules change all the time. Be sure to ask the company providing your equipment before they deliver, as they are almost always ahead of everyone else in knowing the latest rules and regulations.
If a patient has traditional Medicare and a supplemental plan, the supplement will almost always cover the 20% of costs not covered by Medicare. If you are receiving equipment covered by Medicare, be sure that the equipment supplier has all of the patient's secondary insurance information.
Patients covered by Medicare Advantage plans will have to check with their individual insurance carrier about any coverge restrictions, deductibles and co-pay amounts.