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, 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). 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:
Durable Medical Equipment (DME)
Medicare covers durable medical equipment that it considers "medically necessary." Some DME will not be 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?
If you think that a certain piece of equipment would be helpful, talk with your ALS Association care services coordinator and/or your ALS clinic team.
Here is how the Medicare process works:
What do I need to pay for?
Medicare, Medicaid, and private insurance will not cover a number of things that you may need. The good news is that your local ALS Association loan closet can lend you many things. Always talk with your local chapter and ALS clinic team before spending any of your own money.
Examples of devices that are not considered DME:
Check your loan closet!
Every local ALS Association chapter has a loan closet full of small items like pivot discs and larger items like high-end motorized wheelchairs. If an item is available, you can borrow it at no cost for as long as you need it.
- Discuss before you purchase. Always, always discuss your current and future equipment needs with your ALS clinic team and local chapter—before purchasing. They will make recommendations, connect you to resources, explain your options, and guide you.
- Be safe! 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 your physical or occupational therapist and/or asking an ALS Association care services coordinator to come to your home to make recommendations.
- Check the loan closet first. Your local ALS Association has a loan closet full of idle 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.
- Ask if Medicare covers the cost. In general, Medicare pays for the bulk of durable medical equipment. If you have been diagnosed with ALS, you likely qualify for Medicare—even if you are under 65.
- Ask if Medicaid or your private insurance will cover the cost. Find out what your DME coverage is. Medicaid and private insurers often pick up the remaining 20% that Medicare does not cover, though every plan will be different.
- Get a written prescription. When you have to purchase equipment out of pocket, you should get a prescription from your doctor. This will save you money because the equipment provider will not charge you tax on your purchase and then you may be able to deduct it on your federal income tax return.
- Anticipate your needs. Before you need certain types of equipment, research your options and talk with your local chapter and clinic team. Being one step ahead will reduce stress and frustration—and improve your quality of life.
- You should not have to buy, order, or pick up DME yourself. Your ALS Clinic team will coordinate the entire process. However, if you need a piece of equipment sooner than the DME provider’s scheduled delivery to your home, you can ask if you can visit their office in person to pick it up.
- If you desperately need a piece of equipment sooner than you will receive it through the Medicare process, you can either check your local loan closet or pay for it out of pocket (in which case you will not get reimbursed).
- 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—say something to your care services coordinator or ALS clinic contact. You can either get a new piece of equipment or someone can come to your home to show you how it works.
- For DME that are considered rentals by Medicare, you rent the equipment for 13 months. If you no longer need the equipment before the 13-month mark, you should return it to your DME provider. If you still need the equipment after 13 months, it becomes yours. When you no longer need a piece of equipment that you own, you can always donate it to your local ALS Association loan closet.