Medicare Part B and Durable Medical Equipment

Medicare Part B and Durable Medical Equipment

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If you are on Medicare, then you understand that this national social insurance program covers adults aged 65 and over as well as some younger people with disabilities. This program has been around since 1965 and is divided into four parts: A, B, C and D. Medicare Part B is purchasable insurance not covered by Part A, and includes durable medical equipment such as hospital beds.

Definition

Durable medical equipment is considered as any reusable medical equipment including wheelchairs, walkers, home oxygen equipment and hospital beds. It also includes blood glucose monitors, patient lifts, scooters, commode chairs, canes, ventilators, nebulizers and certain pumps.

Your Coverage

Durable medical equipment, including bariatric hospital beds, may be covered under Medicare Part B. If you are not certain that you are covered by Medicare you can call 1-800-633-4227 and speak with a clerk. Your Medigap policy may cover what Medicare does not pay for.

Typically, you pay 20 percent of the amount approved by Medicare once your Part B deductible has been reached. In 2009 that amount was $135; in 2012 that deductible rose to $140.

Certificate of Medical Necessity

It is important for Medicare recipients and families to understand that simply because an item qualifies as durable medical equipment, that it cannot always be purchased and automatically paid for without prior approval. Medicare requires authorization, particularly a Certificate of Medical Necessity from a physician. Equivalent to a medical prescription, this certificate must be completed by the physician. Usually, when you order durable medical equipment, the supplier will work with your physician to ensure that the required paperwork is filled out and submitted to Medicare.

Buying, Renting and Replacing

Medicare gives recipients the option of whether to purchase or rent durable medical equipment. When you rent your equipment, Medicare makes monthly payments for your use of that equipment. Moreover, Medicare determines how long those payments will continue. Thus, if you believe that you will need the equipment longer than Medicare’s established guidelines, then purchasing it is the better choice.

When renting equipment, you can continue to use it as long as you need it. When done, the supplier will pick it up. Furthermore, if repairs or replacement parts are needed, then it is the supplier’s responsibility is to fix it — you are not required to drop the equipment off to the supplier — he must come to you.

Oxygen Equipment

Medicare is regularly updated and the rules clarified. Beginning in 2009, certain changes were made concerning the rental of oxygen equipment and ownership of same.

Prior to 2009, if Medicare recipients needed oxygen and were renting the equipment for 36 months, then after that time the rental payments would end and the patient would own the equipment. The new law has been modified to end rental payments after 36 months, with ownership in the supplier’s hands for five years, if necessary. Under this arrangement, the supplier has been paid by Medicare for five years of equipment rentals and is still responsible for maintaining the equipment. After five years, the patient can reelect to get new equipment — if needed — and start a new 36-month rental payment period and 5-year supplier obligation period.

Considerations

If you rent your oxygen equipment and then move outside of a supplier’s service area, the supplier is still responsible for servicing your equipment. However, the supplier is allowed to make arrangements with a local supplier in your new area, but the new supplier is not permitted to charge you rent if you have exhausted your first 36 months of coverage.

Problems related to your Medicare coverage including your Durable Medical Equipment coverage should be directed to Medicare. A clerk can help resolve a problem, any your questions or explain your coverage.

See Also — Supplemental Medicare Insurance – Putting Coverage in Place before You Need It

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