A power scooter is an example of durable medical equipment covered by Medicare.
Medicare is a federally administered health-care program for elderly and disabled Americans. The elderly and disabled population's health needs often warrant the use of equipment that helps them live their day-to-day lives as easily as possible. If they opt for Medicare's Part B outpatient benefit, some durable medical equipment may be covered.
Definition
Durable medical equipment (DME) refers to a class of medical supplies. These supplies are reusable, used in the home, and used to help an illness or a symptom of an illness. Examples of DME include scooters, hospital beds and prosthetics.
Any medical supplies that must be thrown away are not covered. This includes bandages, catheters and face masks. Medicare makes few exceptions to this. If you are receiving treatment under the home health-care benefit, some nondurable items may be covered as DME, and if you are diabetic, Medicare will cover lancets and test strips.
Eligibility
Before Medicare will cover any DME, a doctor must declare the item medically necessary, writing a prescription or a certificate. In some cases, Medicare requires the doctor to perform tests or examinations before it will cover the item.
What Medicare Covers
If the patient wants Medicare to cover the item, he cannot purchase DME just anywhere: Beneficiaries must go to a Medicare-certified supplier.
Typically, Medicare pays 80 percent of the item's cost, and the beneficiary is responsible for the remaining 20 percent. The beneficiary's supplemental insurance (Medigap, retiree benefits) may cover the remaining coinsurance. However, some suppliers accept Medicare assignment, meaning they take Medicare's payment as the full payment for the item. If this is the case, the beneficiary does not need to pay anything.
Renting vs. Purchasing
Items that are less than $150 must be purchased rather than rented. However, expensive items can be rented instead. Medicare will cover 80 percent of the monthly rental fee (unless the supplier accepts assignment, in which case Medicare fully covers the item). After renting the item for 13 months, the beneficiary owns the item.
Oxygen equipment is an exception to this rule. Medicare will cover monthly rental fees for 36 months, after which the beneficiary no longer needs to pay the rental fee; however, the patient does not own the equipment.
Repairs
If the beneficiary is renting the equipment or it is oxygen equipment, Medicare covers maintenance (cleaning and upkeep of the equipment), repairs and any required parts to make the repairs. This service is a part of the rental fee. If the patient owns the equipment, then Medicare will pay for 80 percent of repairs that are covered under warranty. Maintenance and servicing are not covered.
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