ALS Equipment Overview |
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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.
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What will Medicare cover?
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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:
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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.
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?
You should not have to buy, order, or pick up DME yourself. Your ALS clinic team will coordinate the entire process.If you think that a certain piece of equipment would be helpful, talk with your ALS clinic team or local ALS organization.
Here is how the Medicare process works:
1. Your physician (neurologist or primary care doctor) must write a prescription for each specific piece of equipment. Medicare requires that your physician write the prescription in person. It cannot be done over the phone.
2. Your doctor or ALS clinic will then order the equipment through their preferred local DME provider and schedule a physical or occupational therapist from a home health care agency to visit your home to train you.
3. The DME provider will coordinate payment directly with Medicare, Medicaid, and private insurance before contacting you to discuss payment details. (If the out-of-pocket expense is more than you can afford, do not order the equipment; instead, inquire about alternative options with the DME provider and your local ALS organization.)
1. Your physician (neurologist or primary care doctor) must write a prescription for each specific piece of equipment. Medicare requires that your physician write the prescription in person. It cannot be done over the phone.
2. Your doctor or ALS clinic will then order the equipment through their preferred local DME provider and schedule a physical or occupational therapist from a home health care agency to visit your home to train you.
3. The DME provider will coordinate payment directly with Medicare, Medicaid, and private insurance before contacting you to discuss payment details. (If the out-of-pocket expense is more than you can afford, do not order the equipment; instead, inquire about alternative options with the DME provider and your local ALS organization.)
4. When the DME provider receives the equipment—typically within five to seven days—they will contact you to schedule delivery to your home. If you need a piece of equipment sooner than the DME provider’s scheduled delivery to your home, ask if you can visit their office in person to pick it up.
5. Shortly after the equipment is delivered to your home, the physical or occupational therapist will coordinate a visit to train you how to use it.
Veterans: Your equipment acquisition process will be different than what is described here.
5. Shortly after the equipment is delivered to your home, the physical or occupational therapist will coordinate a visit to train you how to use it.
Veterans: Your equipment acquisition process will be different than what is described here.
What will I need to pay for out of pocket?
Medicare, Medicaid, and private insurance do not cover items that are not considered durable medical equipment, such as:
The good news is that you should be able to borrow many of these items—as well as some durable medical equipment—from an ALS equipment loan closet. Most can lend you small items like pivot discs and larger items like high-end motorized wheelchairs at no cost for as long as you need them. Check with your local loan closet before spending any of your own money.
- built-up utensils
- a shower chair
- a raised toilet seat
- a pivot disc
- a power lift
- a transport wheelchair
- a fully electric hospital bed
The good news is that you should be able to borrow many of these items—as well as some durable medical equipment—from an ALS equipment loan closet. Most can lend you small items like pivot discs and larger items like high-end motorized wheelchairs at no cost for as long as you need them. Check with your local loan closet before spending any of your own money.
Note: Your ALS Guide does not distribute, sell, or help donate used equipment.
Important Tips
- Discuss before you purchase. Always discuss your current and future equipment needs with your ALS clinic team and check with your local ALS organization 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 the healthcare professionals on your medical team.
- Check the loan closet first. Your local ALS organization should have 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.
Additional Information
- 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—contact the company that delivered it or the therapist at your ALS clinic who helped you order it. 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 organization's loan closet.
