Does Medicare cover durable medical equipment (DME)?Medicare coverage for DME
Do you need durable medical equipment (DME)? Medicare covers DME like wheelchairs, hospital beds, pumps and more. Read on to learn about the types of DME that are covered and how to find what you need.
What’s DME?
DME stands for durable medical equipment.
It’s medical equipment that:
- Is durable and reusable
- Is expected to last at least three years
- Is used when you are sick or injured
Your own DME is for use at home, in long-term care or to help you get around. Are you in a hospital, nursing home or skilled nursing facility? They must provide the equipment you need during your stay.
Diabetic supplies like test strips and lancets may also be covered as DME. With a prescription, you can get these items at your local network pharmacy or DME provider.
How do I get the DME I need?
- First, talk to your doctor to get a prescription for your DME. They can send your prescription to a DME provider electronically. Or they can give it to you.
- Then, you can use the provider search tool to find a DME provider. You may need to enter your ZIP code and choose your plan.
- You can search by type of DME or search all providers.
- If a preauthorization (PA) is required, your doctor will need to submit the PA request to Aetna®.
What DME does Medicare cover?
Medicare Part B covers DME when it’s medically necessary. You’ll need to get a prescription from your doctor. Once you do, Medicare covers items like:
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Diabetic supplies, like blood glucose meters (BGMs) and test strips*
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Hospital beds
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Wheelchairs, canes and crutches
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Oxygen and oxygen-related equipment
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Mobility aids, like wheelchairs, scooters and patient lifts
More DME that Medicare covers
Medicare also covers these items and more:*
- Commode chairs
- Continuous glucose monitors
- Continuous passive motion machines, devices and accessories
- Continuous positive airway pressure (CPAP) machines
- Crutches
- Infusion pumps and supplies
- Lancet devices and lancets
- Nebulizers and related medicines
- Pressure-reducing support surfaces
- Scooters (manual and electric)
- Suction pumps
- Traction equipment
DME items you can rent long term
There is some DME you can rent long term. These DME items need to be serviced often to make sure they work well.
Here is how rental works:
- You pay a monthly rental fee.
- You file a claim to get paid back.
- Your rental fee is capped at the item’s purchase price.
If you no longer need the equipment, your monthly fee ends when you return it.
If you need the equipment longer, rental payments continue until you reach the purchase price. After that, further claims are denied. Most rental periods last at least 10 months. Under certain limited circumstances, we will transfer ownership of the DME item to you.
Items that aren’t covered as DME
- Items that modify your home, like ramps or widened doors
- Most items that are used only for comfort or convenience, like air conditioners
- Items that are thrown away after you use them Disposable or single-use items like catheters or surgical facemasks
Will I need prior authorization for DME?
Sometimes.
Prior authorization (PA) is a preapproval process. It helps us make sure a treatment or equipment is medically necessary. It also helps keep your costs down and keep you safe.
- Electric scooters
- Motorized wheelchairs
- Blood glucose meters (BGM)*
- Continuous glucose monitors (CGM)
- Lower limb prosthetics
- Electric stimulator for cancer treatment
If you need a continuous glucose monitor (CGM) from a network pharmacy, you will need a history of insulin use in the last six months to make sure it’ll be covered. Prior authorization for monitors and sensors may apply as well as exception requests if exceeding quantity limits.
Your doctor will submit a PA request for you. PA can take up to two weeks. You can log in to your secure member website to check the status. Or contact Member Services.