Durable Medical Equipment: What Does It Mean, and Is It Covered?

by Medical XPress

When most Americans hear the term “medical expenses,” they’ll likely think of the costs of doctor’s appointments, hospital visits, and medications. But for millions of other Americans, annual medical expenses can also include the cost of certain medical equipment—and, often, that equipment is no cheap. But, luckily, many types of durable medical equipment are covered by most insurances and Medicare. Here’s what you need to know about durable medical equipment, and what is typically covered.

What Is Durable Medical Equipment?

Durable medical equipment, or DME, refers to any medical equipment that you use in your home to improve your quality of life. These are long-term use items that are necessary to help you maintain a certain standard of living. Medical Xpress carries a wide variety of durable medical equipment at our many locations, so feel free to stop by if you have any questions about these pieces of equipment.

What Types of Items Are Considered DME?

Obviously, the definition provided above is rather broad, but luckily, this broad definition means that almost every type of medically necessary device could fall under this umbrella. From items as large as iron lungs, oxygen tents, and hospital beds, to more common items like nebulizers, CPAP machines, catheters, and wheelchairs, all of these pieces of equipment are considered necessary to maintain a certain quality of life for the patient, and so, they fall under the umbrella of DME.

Will Insurance Cover Your Equipment?

While the only people who can answer this question for you specifically are those at your insurance company, we will do our best to give you an idea of what is covered by most insurances. Here’s a quick look at the various DME items we carry, and some information regarding how they are treated by the majority of insurance companies.

Mobility Devices

Wheelchairs are the most common type of mobility device that is covered by medical insurance. If your doctor has determined that you need a wheelchair, you should be able to get at least a portion of the cost covered by your insurance. If you’re looking to upgrade to a power scooter, electric wheelchair, or another type of mobility device, getting the cost covered could be more difficult.

In most cases, these can only be covered if the device is going to be used in place of a wheelchair, and your doctor has deemed it medically necessary for you to have a powered mobility aid, based on your condition. In other words, your medical condition must severe enough that a standard wheelchair is not sufficient to help you maintain a good quality of life. If your doctor states this in writing, your odds of having a powered mobility device covered by insurance improves, but it is still not guaranteed.

Diabetes Equipment

If you’ve been diagnosed with diabetes, the equipment necessary to monitor your condition—namely, blood glucose monitors and testing strips—would be considered DME. In most cases, this equipment would be covered by Medicare or your personal health insurance. It doesn’t matter if you have Type 1 or Type 2 diabetes, and you aren’t required to use insulin either; if you’ve been diagnosed and need to test your blood glucose levels on a regular basis, you should be able to request coverage from your insurance.

Treatment and Therapy Equipment

There are many types of medical conditions that may require at-home treatment or therapy. A few common examples include sleep apnea and asthma. These conditions require regular use of a CPAP machine and a nebulizer, respectively. If there is a piece of equipment you are medically required to use to treat an existing medical condition, it should qualify as a DME, and therefore, be eligible for coverage by most insurances.

Rental Devices

Should you choose to rent your necessary DME instead of purchasing it, this should not impact your eligibility. Most insurances will provide the same level of coverage for the equipment, regardless of whether it is purchased or rented. Medical Xpress and Arlington Medical Supply offer rental options on many types of medical equipment, so be sure to ask about this option if you’re interested.

Lift Chairs

Lift chairs are a tricky type of DME when it comes to having the costs covered by insurance. This is because the lifting mechanism can be considered a medically necessary piece of equipment, but the chair itself often is not. Medicare, for example, only offers coverage for the seat-lift mechanism, and not for the lift chair. So, while you might be able to get partial coverage on this type of purchase, it’s unlikely you’ll be able to have a lift chair fully covered.

If you have any further questions about the DMEs we carry, stop by one of our many Texas locations. If you have questions regarding which DMEs your insurance will cover, it is always best to contact your insurance company and speak to them directly before making a purchase.