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July 6, 2012

Understanding Medicare’s Coverage of Durable Medical Equipment

The Chronicle

Pella — One of the Medicare benefits which causes confusion for many people is durable medical equipment.  These are reusable medical equipment such as walkers, wheelchairs, or hospital beds.  According to Kris Gross from the State of Iowa’s Senior Health Insurance Information Program (SHIIP), “Understanding what Medicare covers and the requirements for coverage can prevent a lot of the frustration for Iowans.”

Anyone who has Medicare Part B can get durable medical equipment as long as the equipment is medically necessary.  It is also required that a doctor or treating practitioner (such as a nurse practitioner, physician assistant or clinical nurse specialist) prescribes it for you to use in your home. You must have the prescription BEFORE you purchase or rent equipment.

For some equipment, Medicare also requires your doctor to fill out a special form and send it to Medicare to get approval for the equipment.  This is called a “Certificate of Medical Necessity.”  Your medical equipment supplier should work with your doctor to see that all required information is submitted to Medicare.

Medicare only covers durable medical equipment if you get it from a supplier enrolled in the Medicare program. This means the supplier has been approved by Medicare and has a Medicare supplier number.  Medicare will not pay claims if the supplier doesn’t have a supplier number.  To find qualified suppliers you can call Medicare at 1-800-633-4227 (TTY 877-486-2048) or go to www.medicare.gov and select “Resource Locator-Medicare Supplier Directory.”

When Medicare approves coverage of your equipment, generally you pay 20% of the Medicare approved amount after you pay your Medicare Part B deductible for the year ($140 in 2012).  Always ask the provider if it accepts “assignment” for the equipment.  This means the supplier agrees to accept Medicare’s approved amount as full payment.  If a supplier doesn’t accept assignment, there is no limit to what it can charge you.  You will have to pay any Part B deductible you owe, the 20% coinsurance and all costs above the amount Medicare approves.

If you are receiving your Medicare benefits from a Medicare Advantage plan, it must cover the same items and services as Original Medicare.

Over 300 SHIIP counselors around the state are available to sit down with you face-to-face to explain Medicare and help with your questions about durable medical equipment.  All services are free, confidential and objective.  

To find the SHIIP site nearest you call 1-800-351-4664 (TTY 800-735-2942), go to www.therightcalliowa.gov or e-mail shiip@iid.iowa.gov.

In the Pella area, call Crossroads of Pella, 320-628-1212 for an appointment with a SHIIP volunteer counselor.

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