Medicare insurance covers numerous types of medical equipment and supplies. Before Medicare will cover it, however, your doctor must document the medical necessity of the equipment or supplies in your medical records. In other words, it just can’t be something that would be convenient to have. People in the hospital, home health care, or a nursing home will have their needs covered by Part A coverage. For people outside those settings, medical equipment and supplies are covered by Part B coverage.
A sample of the equipment covered by Medicare includes:
- Some Catheters
- Ostomy Supplies, ostomy bags, and irrigation and flushing equipment
- Supplies required for feeding tubes (such as catheters, filters, and nutrient solutions)
- Supplies for tracheotomy care
- Dressing required for treatment of a wound caused by a surgical procedure or after debridement (removing non-living tissue of a wound)
- Diabetic supplies, glucose monitors and Diabetic Shoes
- Respiratory supplies including home oxygen equipment
- Vacuum devices for impotence treatment
- Manual Wheelchairs and Electric Wheelchairs
- Augmentative communication devices
- Orthotics and prosthetics, when these devices are considered medically necessary or when they replace or support a body part
- Other supplies and equipment may be covered if they can be shown to be medically necessary and your doctor has documented it in your medical records.
A sample of Equipment that is not covered by Medicare includes:
- Raised toilet seat
- Shower/commode wheelchair
- Grab bars and other safety equipment for the bathroom
- Hearing aids
- Examination gloves
- Some Catheters
What Does It Cost Me to Buy Equipment or Supplies?
How much you pay for equipment and supplies will depend on whether or not you have Part B coverage and where you buy your equipment. However, in general, if you are enrolled in Medicare Part B:
- You will pay 20% of the approved Medicare amount after you have met your yearly deductible (if you do not have secondary insurance).
- You may owe little to nothing if you receive your Medicare through a Medicare Supplement or a Medicare Advantage Health Plan – depending on the plan you are signed up with and your benefits with the plan. It is important to do your homework.
Where Do I Purchase Supplies and Equipment?
You will save money if you order your items from a Medicare approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your equipment from any store that sells it. However, if the supplier from which you order is not enrolled in Medicare, Medicare will not pay for the durable medical equipment.
There are two types of Medicare suppliers, participating suppliers and those who are enrolled, but have chosen not to participate. A Medicare approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up your order. In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple months to receive payment. If you receive your Medicare coverage through a Medicare Advantage Plan (HMO or PPO), it is likely that the plan will have its own steps for equipment purchases.