Equipment for Everyday Living

Medical Alert Systems

• Will Medicare Cover Medical Alert Systems?
  
  Medicare does not cover medical alert systems, neither will most medical supplement insurance carriers, even with a doctor’s written prescription. However, you should check with your insurance provider to see if they will cover your medical alert system. Some states have programs that will help Medicare beneficiaries, who meet certain criteria, pay for the alert systems. These programs are usually accessed through the local County Aging Services.

How Much Will a Medical Alert System Cost Me?

The best choice of a medical alert system for you will depend on your particular situation, budget, and needs. Here are some questions to ask before choosing a service:

• Is the service’s call center outsourced or subcontracted, or owned by the equipment supplier?
• Does the call center handle more than medical emergencies (home alarms, etc.)?
• Are the phone operators trained and certified and who does the training?
• What are the hours of operation for the call center?
• How does the call center ensure 100% uptime?
• Does a live operator answer all calls? If not, in what circumstances would a call go to voicemail?
• How does the call center handle your personal confidential medical information?

Other things to consider:

Cost: There are two costs to medical alert services: the upfront equipment costs and the monthly service fees. Some companies charge activation or installation fees. The monthly service is the largest cost over time. Ask about payment options and contractual commitments.

Warranty/Service: When comparing medical alert companies, find out if there is a refund policy, in case you are not satisfied with the service. Also, find out how the base unit and transmitter are serviced and maintained, as well as how they are replaced in the event they break or are lost.

Medical Alert System Features and Services

Medical alert companies offer a variety of features for their equipment. Features can include:

• Easy to read displays and illumination
• Braille lettering
• LED indicators for power (power on, low battery) and alarm status (shows if the alarm has been activated or not)
• Remote telephone answering capabilities, which allows you to answer and disconnect regular phone calls using your transmitter
• Backup power so that it will operate in event of a power outage

Types of services available include:

• Fall monitoring: This involves the use of a transmitter that detects falls, abnormal body movements, and/or extended periods of inactivity. When a fall or an unusual period of inactivity occurs, the system will automatically summon assistance. These special transmitters also have a button where the user can call for help manually.
• Call check-in: With this service a live operator will attempt to contact you via telephone at certain times during the day. When contact cannot be made in a specified time, your designated contacts will be notified.

What Should I Consider When Choosing a Medical Alert System Provider?

Medical alert systems are designed to provide help during an in-home emergency. They are useful for people who live alone and are at risk for medical emergencies such as heart attack, stroke, falls, and when someone needs monitoring during recovery from surgery. They can be life saving for anyone who may face an in-home medical emergency.
Medical alert systems attach to an existing phone line and you wear a small waterproof transmitter around your neck or wrist, which is pressed when there is an emergency. When pressed, the transmitter sends a signal to the in-home base unit, which dials a call center, where the call is answered by an operator. You will be able to speak to the operator without having to go to the phone. In fact, the more powerful systems are able to transmit conversations from most rooms in a home, even if the base unit is in one main room.

Once contact is made, the operator will ask you questions and arrange for the appropriate help. If the operator cannot make contact with you for any reason, the operator will immediately call for help. You or your family normally provides a list of contacts for this service, but in a real medical emergency the operator will call emergency medical personnel immediately.

There are three parts to medical alert systems:

The panic button: Which is can be a worn around the wrist or neck (it should be worn at all times).
The base unit: Which is plugged into a telephone jack.
A rescue alert response center: Which has 24-hour attendants who answer and respond to your needs.

Medical Identification Tags

There are different types of medical identification (ID) tags currently in use. The most common medical ID is jewelry such as a bracelet or tag that you wear around your neck. These tags have a logo or inscription indicating a particular medical condition. There is now new technology available that allows you to carry your own information on a USB device (flash drive).

What is a USB Medical ID Tag?

A USB personal medical ID tag is a digital device that holds your emergency information and your health history. Any emergency service, ambulance, rescue squad, or doctor with a laptop computer can have instant access to all of your personal health information. This device is easily identifiable as a medical alert tag. It can be worn on the body or put on a key chain. There is even one brand flat enough to be carried in a wallet.

Why is it better than a regular ID tag?

Medical jewelry tags have limited information available. Because the USB medical identification tag is a digital device, it can carry much more information than a metal tag. Since it is loaded into a computer, it can also be updated as your medical history changes.

How do you use it?

The device is simple to use. You can buy just the USB device, plug it into a USB port on your computer, and fill out the form yourself with as much information as you need.
You can also order one from a company that will get your medical records, digitally scan and organize them on your USB medical tag, and then send it to you. They will also update your records as needed.

How much does it cost?

The device sells for about $29.95 – $39.95. For a monthly subscription fee, some companies will compile and update your medical records as your information changes.

Where do I get it?
There are many companies that carry this device. Your doctor may be able to give you a contact. You can also look for companies on the Internet.

How safe is it?
The USB device is very secure. Information on the device is protected with a username and password. No files or software are added to your computer. All medical records are encrypted for your safety.

Hearing Aids

• What Do I Need To Know About Hearing Aids?The AARP states that hearing loss is common as people age. The main type of hearing loss is sensorineural. This type of hearing loss is caused by damage and deterioration to the hair cells inside the ear, which is common during aging.
  
  You may want to talk to your doctor about hearing aids if:
• Straining to hear makes you feel tired
• You have to be looking at someone’s mouth to understand him or her
• You have difficulty understanding words in public or normally loud places, such as a car or restaurant
• You often ask others to repeat what they said
• You have trouble hearing the telephone, doorbell, or alarms

Do I Need A Hearing Aid Exam?

If you feel as though you are suffering from hearing loss, you may want to ask your physician for a hearing exam. If your doctor does not conduct hearing exams, he or she will direct you to a hearing aid professional.

There are two main types of hearing exams. In regards to hearing aids and Medicare, it is important to know that only certain hearing exams are covered by Medicare.

• Regular hearing exams, which are similar to general health checkup exams, are not covered by Medicare.
• The other type of hearing exam is a diagnostic hearing aid exam. This type of exam is based on a medical need, such as loss of hearing due to illness or surgery. Diagnostic hearing exams are prescribed by a physician, and are covered by Medicare as long as they are prescription-based due to a medical need.

How Do I Get a Hearing Exam?

A hearing aid professional may be an audiologist, otolaryngologist, or hearing aid specialist. A professional can help you discover the type of hearing loss you have and if a hearing aid is the right option for you. A hearing aid professional, such as an audiologist, will be able to test your hearing using a variety of equipment. This will evaluate the type of hearing aid you need, if you need one. The hearing aid professional will recommend and fit a hearing aid to your individual needs and lifestyle.

After your doctor or audiologist has completed a hearing exam for your individual needs, they will help you choose the type of hearing aid you need. When looking for a hearing aid specialist make sure that they:

• Are licensed and certified
• Have the correct testing equipment and a sound controlled room
• Offer a variety of hearing aids
• Work with you, and you are comfortable with them
• Explain costs, warranties, and trial periods
• Seem competent and offer after-purchase support

What Happens During a Hearing Exam?

During your hearing exam, you will be asked a variety of open-ended questions that help the examiner see how hearing loss impacts your daily life. You want to be specific about when, where, and how you have the most trouble hearing. For example, at home alone you can hear the television fine, but at a noisy coffee shop you have trouble hearing your friends. Explanations such as this help the hearing aid specialist determine the type of hearing aid that fits your lifestyle. The hearing exam will also question medications, ear pain or drainage, surgical history, dizziness or vertigo, and if you experience ringing in your ears.

The hearing exam will also use special equipment to test the type of hearing loss you have. In a sound-controlled booth, you will wear headphones or earphones that make a tone or word. The examiner will ask you to push a button when you hear the sounds. This will test the ability of your ears to recognize speech and tones based on the level of pitch and intensity. Remember that you may have to return to the hearing aid professional’s office for further testing, depending on your individual needs and the types of sounds that you can or cannot hear.

Does Medicare Cover Hearing Exams and Hearing Aids?

In general, Medicare does not cover routine hearing exams or hearing aids of any type. In some cases, diagnostic hearing exams are covered by Medicare Part B, but this is only when they are ordered by a doctor. If your hearing problem is due to a specific injury or disease—such as removal of a brain tumor or head injury—Medicare may cover the charges. Your doctor or hearing specialist will be able to explain which hearing exams are covered by Medicare, and the conditions for a diagnostic hearing exam.

You pay 100% of charges for routine hearing exams and hearing aids. If you are approved by your physician for a Medicare-covered diagnostic hearing exam, you pay 20% of the charges. You must pay your deductible for any Medicare Part B services and supplies before Medicare begins to pay its share. If a doctor, health care provider or supplier does not accept assignment, the amount you pay may be higher.

Traction Equipment

• Medicare Coverage of Traction EquipmentMedicare will cover most of the cost of traction equipment if you have an illness or condition that requires traction equipment to be available in your home for therapy. Medicare payment for the traction equipment is subject to the requirement that the equipment is medically necessary and reasonable for treatment of an illness or injury and/or to improve the functioning of a body part. To ensure that Medicare pays for the traction equipment, you must follow the steps below:
• Only your doctor can prescribe the equipment for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you.
• The doctor must document your need for the traction equipment by writing the information in your medical records and by giving you a signed and dated order (prescription) for it.
• The supplier must receive the order before Medicare is billed and it must be kept on file by the supplier.
• If you receive your Medicare through a one of Medicare Advantage Plans (like a HMO or PPO) it is likely you will have to follow the plan’s steps for approval and purchase. Make a point of calling your plan’s customer service number and ask about their steps for coverage of traction equipment.

Costs for Traction Equipment

How much you pay 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.
• You will pay less if you buy from a supplier who accepts assignment. A supplier who accepts assignment has agreed not to charge more than the Medicare-approved amount and will not ask for more than your 20% copay.
• You might not have a copay if you have Medigap/Medicare Supplemental Insurance.
• You may owe little to nothing, if you receive you Medicare through a Medicare Advantage Plan, depending on the plan you have and your benefits with that plan.

Ordering Traction Equipment through a Medicare-Approved Provider

You will save money if you order your item 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 traction equipment from any store that sells them. However, if the supplier from which you order your traction equipment is not enrolled in Medicare, Medicare will not pay for the equipment.

Things you should think about before you choose a supplier:

• There are two types of Medicare suppliers: participating suppliers, and those who are enrolled but have chosen not to participate. Participating suppliers must accept assignment, which means they will not charge more than the Medicare-approved amount for the traction equipment.
• 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% above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the equipment. In this situation Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple of months to receive payment.
• If you receive your Medicare coverage through a Medicare Advantage Plan (like a HMO or PPO), it is likely that the plan will have its own steps for equipment purchases. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers—they cannot supply less. Depending on your plan, you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan’s customer service and ask about your coverage before you order your traction equipment.

To qualify for traction equipment, you:

• Must have a musculoskeletal or neuralgic impairment requiring traction equipment.
• Must have been shown how to use the device and have demonstrated that you can tolerate it.
• Must meet any other necessary criteria, depending on the particular piece of equipment your doctor has ordered.

Medicare Part B and Traction Equipment

You must have Medicare Part B coverage and your doctor must have documented your need for the equipment and written you an order (prescription) for the equipment. There is a wide range of traction equipment available and the specific coverage criteria will vary. Your doctor or supplier will know what is necessary to qualify for the type of equipment that they prescribe for you. In order for any item to be covered under Medicare, it has to meet the test of durability.

Medicare will pay for medical equipment when the item:

• Withstands repeated use
• Is used for a medical purpose
• Is useless in the absence of illness or injury
• Is for use in the home

Orthopedic Footwear

• Does Medicare Cover Orthopedic Shoes?There are several types of orthopedic shoes and many types of covered products for leg braces. If they are an integral part of a covered leg brace, Medicare will cover:
• Oxfords
• High tops
• Depth inlays
• Custom shoes for non-diabetics

If they are also medically necessary for the proper functioning of the brace, Medicare will cover:

• Heel replacements
• Sole replacements
• Shoe transfers

Patients with partial foot amputations can have their prosthetic shoes covered if they are an integral part of the prosthesis.

Some of restrictions that apply to coverage include:

• The billing for the shoe and brace must come from the same supplier.
• A properly detailed order for the prosthesis must be signed and dated by the treating physician.
• The order for the prosthesis must be kept on file with the supplier in the event it needs to be made available to the Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC).
• Shoes, inserts, and modifications for patients with diabetes are covered under Medicare’s Diabetic Footwear policy.

How Much Do You Pay for Orthopedic Shoes?

You pay for 20% of the Medicare-approved amount under Medicare Part B. You must pay your deductible for any Medicare Part B services and supplies before Medicare begins to pay its share. If a doctor, health care provider or supplier does not accept assignment, the amount you pay may be higher. It is extremely important that your supplier is a participating supplier in the Medicare Program. If a supplier of your durable medical equipment (DME) does not accept assignment there is no limit to what you may be charged. You may also have to pay the entire bill (including Medicare’s share) at the time you get your DME.

Ostomy Supplies

• Costs in Relation with Ostomy SuppliesHow much you pay will depend on whether or not you have Part B coverage and where you buy your equipment.In general, if you are enrolled in Medicare Part B.
• You will pay 20% of the approved Medicare amount, after you have paid your yearly deductible.
• You will pay less if you buy from a supplier who accepts assignment. Participating suppliers will not charge more than the Medicare-approved amount.
• You may owe little to nothing, if you receive your Medicare through a Medicare Advantage Plan, depending on the plan with which you have signed up and your benefits with the plan.
• You may owe little to nothing if you have a Medigap/Medicare Supplemental policy.

Qualifying For Ostomy Supplies Coverage

You must have Medicare Part B coverage and your doctor must have documented your need for the supplies in your medical records. The doctor must also write you an order (prescription) for the supplies clearly stating which supplies you will need. Your doctor will know what is necessary to qualify for the type of supplies prescribed for you. You are allowed up to a three-month supply at one time.

Ostomy supplies are covered for people with a:

• Colostomy
• Ileostomy
• Urostomy

Medicare may cover (depending on your individual needs):

• Pouches (1-piece, 2-piece, locking, drainable, closed)
• Skin barrier wafers
• Eakin Cohesive (T) Seals
• Paste
• Powder
• Barrier wipes
• Adhesive remover
• Deodorant drops
• Cleaner/decrystallizer
• Tape
• Belts (appliance)

Will Medicare Pay For My Ostomy Supplies?

Medicare will cover most of the cost of ostomy supplies if you have a condition that requires them. To ensure that Medicare pays for your ostomy supplies, you must follow the steps below:

• Only your doctor can prescribe the supplies for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you.
• The doctor must document your need for ostomy supplies in your medical records and give you a signed and dated order (prescription) for them.
• The supplier must receive the order before Medicare is billed and it must be kept on file by the supplier.
• If you receive your Medicare through a one of Medicare Advantage Plans (like an HMO or PPO) it is likely you will have to follow the plan’s steps for approval and purchase. Make a point of calling your plan’s customer service number and ask about their steps for coverage for ostomy supplies.

Where to Buy Ostomy Supplies

You will save money on your ostomy supplies if you order from a Medicare-approved supplier. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your supplies from any store that sells them. However, if the supplier from which you order your ostomy supplies is not enrolled in Medicare, Medicare will not pay for them.

Things you should think about before you choose a supplier:

• There are two types of Medicare suppliers: participating suppliers, and those who are enrolled but have chosen not to participate.
• Participating suppliers will not charge more than the Medicare allowed amount.
• Medicare-approved suppliers who do not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15% above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the supplies. In this situation Medicare will send the reimbursement directly to you. Be prepared to wait; it may take a couple of months to receive payment.
• If you receive your Medicare coverage through a Medicare Advantage Plan (like an HMO or PPO), it is likely that the plan will have its own steps for equipment purchases. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers — they cannot supply less. Depending on your plan you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan’s customer service and ask about your coverage before you order any ostomy supplies.
• If you are enrolled in a Medigap or Medicare Supplement plan you could owe little to nothing for your ostomy supplies.