Before my mom started needing care in her late 70s, I never gave much thought to how someone gets their hands on a wheelchair, hospital bed, or other necessary medical supplies. Probably because up until then, my family had led a pretty charmed life in terms of our health—no broken bones, hardly any hospital admissions. But after a significant medical event, my mom suddenly needed all kinds of medical gear. And my family had to take a crash course on how to find and pay for it. Well, we would have, if a crash course had existed. Mostly we learned by doing, and we didn’t always do it right.

To help all family caregivers do it better than my sisters and I did, I present Durable Medical Equipment 101. Here, I’ll share the helpful info family caregivers need to know in order to acquire necessary durable medical equipment, and how to afford it.

What is Durable Medical Equipment?

Durable medical equipment (DME) refers to medical equipment ordered by healthcare providers for everyday or extended home use, in order to assist individuals who have medical needs. This equipment must be:

• Durable (able to withstand repeated use)
• Generally has an expected lifetime of at least three years
• Used for a medical reason
• Not usually useful to someone who isn’t sick or injured
• Used in the home or a long-term care facility (if the person is in a skilled nursing facility as part of a stay covered under Medicare Part A, the facility is responsible for providing any DME)

DME includes a wide range of devices, including (but not limited to):

• Canes
• Commode chairs
• Continuous passive motion (CPM) machines
• Crutches
• Glucose monitors and supplies
• Hospital beds
• Infusion pumps and supplies (when necessary to administer certain drugs)
• Manual wheelchairs and power mobility devices (eg: power wheelchairs or scooters needed for use inside the home)
• Nebulizers and some nebulizer medications (if reasonable and necessary)
• Oxygen equipment and accessories
• Patient lifts to help transfer a patient from a bed or wheelchair
• Pressure-reducing beds, mattresses, and mattress overlays used to prevent bed sores
• Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
• Suction pumps
• Traction equipment
• Walkers

If a doctor or other health care provider (nurse practitioner, physician’s assistant, or clinical nurse specialist) prescribes any of the above DME for an older adult who’s on Original Medicare, Medicare Part B will cover a portion of the cost of the equipment. Medicare Advantage plans (a.k.a. Medicare Part C or “MA” plans) cover the same medically necessary DME that Original Medicare covers.

How to get Durable Medical Equipment

Okay, let’s say we have the prescription for the walker or glucose monitor or commode chair. Now what?

If we want Medicare or our MA plan to cover it, we have to get it from a Medicare-enrolled supplier. This is a supplier that Medicare or the MA plan has approved and assigned a Medicare supplier number to. In order to enroll and remain enrolled in Medicare, suppliers must meet strict standards. Suppliers that aren’t enrolled can charge as much as they want for DME because they’re not subject to Medicare’s cost limitations. If a supplier isn’t enrolled, Medicare won’t cover the DME they provide.

We can find approved Medicare suppliers in our area by visiting Medicare.gov/medical-equipment-suppliers. 

Important questions to ask the DME supplier

The first two questions we absolutely need to ask will help us understand if Medicare will pay our claim and give us an idea of how much of it will be covered.

‍“What is your Medicare supplier number?”‍

If they can provide this number, this will confirm that they’re approved by Medicare, and that Medicare will pay our claim.

‍“Do you agree to accept the Medicare-approved amount as full payment?”

If they answer, “Yes,” we’ll pay less out of pocket for the equipment.

Other questions Medicare recommends we ask are:

"Do you accept assignment?"

If they say, “Yes,” that means they can charge only the coinsurance and Part B deductible for the Medicare‑approved amount. This means our out-of-pocket costs may be less.

Suppliers that accept assignment also usually wait for Medicare to pay its share before asking us to pay our share. They also have to submit our claim directly to Medicare.

If they say, “No,” they’re considered “non-participating” suppliers. We might have to pay more for their DME.

"If you don’t accept assignment, will you consider assignment in my case?"

Some suppliers haven’t agreed and/or aren’t required by law to accept assignment for all Medicare-covered DME, but they can still choose to accept assignment for individual services. If they do, this could lower our out-of-pocket costs.

"If you won’t consider assignment, what’s your non-assignment charge?"‍

It doesn’t hurt to ask, in case their cost is lower than the portion we would have to pay through Medicare.

"Will you bill Medicare for me?"‍

This takes some paperwork off our desk.

Are the DME rules the same for Medicare Advantage plans?

If our family member has an MA plan, there may be differences in the approved suppliers and our out-of-pocket costs. It’s best to contact the insurance company that offers the MA plan to find out who their medicare-approved suppliers are. If the MA plan won’t cover a DME item that’s been prescribed, we can contact the insurance company that offers the MA plan and request to appeal the denial of coverage.

RubyWell is currently building a MA Benefits Navigator tool that family caregivers can use to easily access information about family members’ supplemental benefits. These are the benefits that go above and beyond traditional Medicare Parts A & B benefits. And they can be very valuable. This tool will provide detailed information about the DME benefit for each MA plan. To be among the first to use RubyWell's MA Benefits Navigator, join our waiting list. 

How to Pay for Durable Medical Equipment

When Medicare covers DME, in most cases it’s on a rental basis. The nice thing about renting DME is that the supplier must maintain, repair, or replace the equipment whenever necessary. Medicare only covers the cost of purchasing inexpensive or common items like canes, walkers, blood sugar monitors; or complex rehabilitative power wheelchairs. After the Part B deductible is met, we pay 20% of the Medicare-approved amount to rent or purchase the equipment if our supplier accepts assignment.

For some expensive equipment, like standard wheelchairs and hospital beds, Medicare covers the rental costs for the item for 13 months of continuous use. After 13 months, the supplier will transfer ownership of the equipment to our family member.

For more details about accessing DME for an aging family member enrolled in Medicare, check out this PDF created by Medicare.gov.

Other DME Resources

Medicare coverage of durable medical equipment isn’t the only way to save on these expenses. We can also access this type of equipment through medical equipment banks, state assistance programs, non-profit organizations, and thrift stores.

Medical equipment banks are often run by charitable organizations. They refurbish DME and offer it for free or at low rental rates. Google “medical equipment bank near me” to find one.

State-based assistance programs like Assistive Technology Projects provide access to durable medical equipment with minimal fees. To find a nearby Assistive Technology Project, Google “Assistive Technology Project in [state].”

Non-profit organizations and loan closets offer surplus equipment for short-term use or at low prices. My sisters and I discovered a loan closet in our area and continue to make good use of it.

Thrift stores run by organizations like Goodwill or Habitat for Humanity may have DME available. We’ll just want to make sure it’s in good working order before purchasing.

The range of solutions for DME is fairly broad. We can consider a mix of used and new, loaned and purchased. Using the resources listed above to help locate what works for our family is a great first step.

At RubyWell, we’re leaving no stone unturned as we pave a path to financial stability for all family caregivers. Our Family Leave Finder provides state-by-sate info on family leave laws. Soon, family caregivers will be able to make the most of a loved one’s health insurance benefits, including maximizing DME coverage, with our Medicare Advantage Benefits Navigator. And ultimately, we're developing compensation solutions so that every family caregiver can be a paid caregiver. If you’d like to be among the first to hear about future products, join our waiting list.
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I hope this article has been helpful for you. Feel free to share it with family or friends who are looking for ways to lower their cost of caring.

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