Medicare can seem complicated to the casual observer and be a bit difficult to understand, but it can really be a lifesaver when you have expensive medical needs. The case in question is one of durable medical equipment, which can be critical to the successful treatment of medical needs but can be sometimes impossible to afford on your own. Here are some of the criteria used by Medicare to decide if your medical equipment falls under the heading of "durable medical equipment," which would allow you to obtain the equipment with only a small portion paid out-of-pocket.
1. Prescribed and "medically necessary"
Of course health insurance always wants to know if things are "medically necessary" before financing them. Fortunately, your doctor can weigh in on this by specifying that certain prescribed equipment, such as a walker or blood sugar monitor, is necessary for the successful treatment of your medical condition. It's unlikely that you'd want to use a walker for cosmetic reasons, but apparently Medicare just wants to make sure.
2. Only for medical use
Medicare doesn't want to pay for something that you might normally use around the house when you're not sick. The point is that you should be able to pay for something like that yourself without resorting to insurance, because your insurance is specifically for financing health needs. So not everything that your doctor prescribes will count as medical equipment if it also has other uses around the home.
3. Used in your home over and over
In-home use is an important part of the definition of durable medical equipment; the item needs to be something kept at your house (or on your person) and used there, primarily for medical reasons, over and over. If something can be used on the go, like crutches, that doesn't necessarily mean it doesn't count. If it's disposable, though, it's unlikely to count as durable medical equipment (that's probably where the "durable" part comes in). There are exceptions to this, such as blood sugar test strips for diabetes, which are generally not supposed to be reused. So if you're unsure about whether something counts are "durable" or not, talk to your doctor about it.
These three qualifications are just general rules to help you determine if what you've been prescribed is likely to be covered by Medicare. Remember, though, that even if it is, you'll be required to pay a percentage of the total out-of-pocket. This should be a relatively small amount, but the more expensive the equipment is, the more likely it is to be a strain on your finances, so if you can save up in advance, do so.
For more information about durable medical equipment, talk with an equipment supplier, such as Hospital Pharmacy West.
Share21 February 2017
When my mother fell at home and broke her hip, we all thought that we were going to have no choice to put her in a nursing home when she got out of the hospital. My mother had always asked us kids to avoid putting her in any kind of home, but we didn’t know what else we could do. None of us were capable of giving her the kind of rehabilitation and care that she needed. Then her doctor suggested that we find out if her insurance covered in-home care. I didn’t even know that that was an option. I was pleased to discover that in-home care was covered by her plan. Now she gets great care from nurses and nurse assistants that come right to her in her home, where she wants to be. It’s a great option, and I’m so glad we have it.
