Medicare Home Medical Equipment (DME)
By Mike Kuller, RPh
To receive home medical equipment (DME) under a Medicare Part B benefit, you must get it from a company contracted with Medicare as a provider (Allstar Medical Supply is not a Medicare provider – another company I used to own from 1999 to 2012, Allstar Oxygen Services, was a Medicare provider).
Medicare will not reimburse you if you purchase medical equipment from a company that is not one of their contracted providers.
As of January 1, 2019, there are no medical equipment providers contracted with Medicare in Alameda or Contra Costa Counties.
How Did We Get Here?
There used to be about a dozen different DME companies in the area and they were all contracted with Medicare. In 2013 Medicare implemented a Competitve Bidding Program to reduce the number of companies they had to deal with nationally and to lower their costs. They put the products they cover out to bid.
The reslut is they eliminated 70% of the companies from their program and reduced the fees they reimbursed them by over 50%. The companies that "won" the bids either closed up or eventually went out of business.
What does Medicare cover?
Medicare will pay 80% of their rate (if you have a supplemental plan or Medicare Advantage, they will pay the remaining 20%) for certain items of home medical equipment as long as you meet their qualifying needs for each item.
Most other health insurances copy the Medicare guidelines and may also require forms signed by the MD and notes from your clinical chart to document your need.
Semi-electric hospital bed – Qualifications:
1. Need to change body positions in ways not possible with a normal bed, or
2. Need to be in body positions not possible with a normal bed in order to relieve pain, or
3. Need to have the head of the bed higher than 30 degrees most of the time due to illnesses such as congestive heart failure, chronic pulmonary disease, and others, or
4. Use of use traction equipment that must be attached to a hospital bed.
Standard wheelchair (weighing around 40lbs) – Qualifications:
1.Significant mobility limitations that interfere with activities of daily living in the home.
2. The mobility limitations cannot be resolved with a walker.
Medicare does not pay for the lighter “transport wheelchairs” because the patient can't self-propel in them.
Front-wheeled walker – if you have difficulty walking or keeping your balance you may qualify for a walker. Qualifications:
1. Significant mobility limitations that interfere with activities of daily living in the home.
Bedside commode –Qualifications:
1. Unable to walk
2. Or there is no bathroom on your floor
If you are able to walk, they may provide you with a walker but they will not pay for both a walker and bedside commode if there is a bathroom on your floor.
Medicare does not pay for any other bathroom equipment.
To Find a Medicare Supplier
To find the closest Medicare supplier, go to this site and type in your zip code. Then check the box of the equipment you need.
If you have Medicare Advantage or another insurance plan, you will have to call them to find who their contracted DME (durable medical equipment) provider is. That is the only company they wil reimburse for medical equipment.