|
Having the right equipment at the right time can improve your quality of life and extend your independence. However, paying for equipment can be expensive. By learning about health insurance and equipment loan closets, you can save thousands of dollars—and get the equipment you need.
|
|
What will Medicare cover?
Medicare should pay for 80% of the cost to purchase (or rent) durable medical equipment (DME) that is covered. Medicaid and/or private insurance should pick up the rest. Medicaid benefits will vary by state, and private insurance benefits will vary by provider and plan.
Examples of durable medical equipment that are covered:
Examples of durable medical equipment that are covered:
- walkers
- standard wheelchairs
- custom tilt-and-recline power wheelchairs
- manual patient (Hoyer) lifts
- speech-generating devices
- bilevel (BiPAP) machines
- cough assist machines
- standard hospital beds
|
|
|
Durable Medical Equipment (DME)
Medicare covers durable medical equipment that it considers "medically necessary." Some DME is not covered. Medicaid and private insurance usually follow Medicare's guidelines. In order to get a piece of equipment covered, it must be properly documented by your doctor.
Medicare covers durable medical equipment that it considers "medically necessary." Some DME is not covered. Medicaid and private insurance usually follow Medicare's guidelines. In order to get a piece of equipment covered, it must be properly documented by your doctor.
How do I order durable medical equipment?
Your ALS clinic team or doctor’s office will coordinate with a durable medical equipment company to get you the right equipment. If there is a specific piece of equipment you think would be helpful, talk with your ALS clinic team, physician, or local ALS organization.
Here’s how the Medicare process works:
1. Medicare requires that you have a face-to-face visit with your physician. Your physician will then write a prescription and document your medical need for each piece of equipment.
2. Your doctor or ALS clinic will then order the equipment through a local DME provider that will contact you directly about the delivery. Depending on the type of equipment being delivered, your doctor may submit an order for a physical or occupational therapist from a home health agency to come to your home to show you how to properly use the equipment.
3. The DME provider works directly with Medicare, Medicaid and private insurance and will submit for authorization prior to delivery. The DME provider will work with you directly if there are any out-of-pocket expenses that your insurance(s) will not cover.
1. Medicare requires that you have a face-to-face visit with your physician. Your physician will then write a prescription and document your medical need for each piece of equipment.
2. Your doctor or ALS clinic will then order the equipment through a local DME provider that will contact you directly about the delivery. Depending on the type of equipment being delivered, your doctor may submit an order for a physical or occupational therapist from a home health agency to come to your home to show you how to properly use the equipment.
3. The DME provider works directly with Medicare, Medicaid and private insurance and will submit for authorization prior to delivery. The DME provider will work with you directly if there are any out-of-pocket expenses that your insurance(s) will not cover.
Veterans: Your equipment coverage and acquisition process will be different than what is described here. Discuss with your medical team at the VA. Learn more
What will I need to pay for out of pocket?
Medicare, Medicaid, and private insurance do not usually cover items they don't consider medically necessary, such as:
You may be able to borrow some of these items from an ALS equipment loan closet at no cost for as long as you need them. Check availability at your local loan closet before paying for equipment out of pocket. If items are not available at a loan closet, you can purchase them using our ALS Equipment Guide.
- built-up utensils
- shower chairs
- raised toilet seats
- pivot discs
- power patient (Hoyer) lifts
- transport wheelchairs
- fully electric hospital beds
You may be able to borrow some of these items from an ALS equipment loan closet at no cost for as long as you need them. Check availability at your local loan closet before paying for equipment out of pocket. If items are not available at a loan closet, you can purchase them using our ALS Equipment Guide.
Note: Your ALS Guide does not distribute, sell, or help donate used equipment.
Additional Tips
- Always discuss your current and future equipment needs with your ALS clinic team and/or physician before purchasing. They will make recommendations, connect you to resources, explain options, and guide you.
- Before buying or using any type of medical equipment, you need to make sure that it is not only right for you, but also safe for you. This is best done by talking with the healthcare professionals on your medical team.
- Your local ALS organization should have a loan closet full of equipment. Before spending any of your own money, always ask about borrowing it—for free—for as long as you need it. When done, return items promptly so others can use them. You can also help others by donating items you purchased but no longer need.
- Anticipate your needs. Before you need certain types of equipment, research your options and talk with your local organization and clinic team. Being one step ahead will reduce stress and frustration—and improve your quality of life.
- In general, Medicare pays 80% of the durable medical equipment cost. If you have been diagnosed with ALS, you likely qualify for Medicare—even if you are under 65.
- If you have Medicaid or private insurance as a secondary insurance, you will want to find out what your DME coverage is. They often pick up the remaining 20% that Medicare does not cover, though every plan will be different.
- Always get a written prescription. When you have to purchase equipment out of pocket, the equipment provider should not charge you tax on your purchase if you provide the prescription. You may also be able to deduct it on your federal income tax return.
- If you get a piece of equipment that doesn’t feel right or isn’t working—or if you’re still not sure how to use it—contact the company that delivered it or the therapist at your ALS clinic who helped you order it. They will send someone to your home to help you figure it out or make adjustments.
For DME that is considered a rental by Medicare, you rent the equipment for 13 months and after that it becomes yours. Medicare will cover repairs and replacement parts once the DME is purchased. If you no longer need the equipment before the 13-month mark, you should return it to your DME provider. When you no longer need a piece of equipment that you own, you can always donate it to your local ALS organization's loan closet.
