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Medicare coverage for durable medical equipment

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?

Most DME is medical equipment that’s durable and reusable. It’s expected to last at least three years. It’s equipment for when you’re sick or injured.

 

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.

 

Your own DME is for use at home, in long-term care or to get around. If you’re in a hospital, nursing home or skilled nursing facility, they should provide all the DME you need for your stay.

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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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  • 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 
    • Patient lifts 
    • Pressure-reducing support surfaces 
    • Scooters (manual and electric)
    • Suction pumps 
    • Traction equipment 

    • 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, like catheters or surgical facemasks

     

  • There is some DME you can rent long term. These DME items need to be serviced often to make sure they work well. You would pay a monthly rental fee for these items and file a claim with us to get paid back.

     

    If you no longer need the item, your monthly fee will end when you return your DME. If you need this DME for a longer time, your monthly rental fee will be capped at the item’s purchase price. (After you reach the purchase price, we would deny further claims.) Most times, these payments take place over at least 10 months.

 
 

How do I get the DME I need?

 

  1. First, talk to your doctor to get a prescription for your DME. They can send your prescription to a DME provider electronically or give it to you.
  2. 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.
  3. You can search by type of DME or search all providers. If you want your plan to help with the cost of your DME, make sure the provider is in your plan’s network.
  4. If a preauthorization (PA) is required, your doctor will need to submit the PA request to Aetna.
 

Will I need prior authorization for DME?

 

Prior authorization (PA) helps us make sure a treatment or medicine is medically necessary. It’s a preapproval process that helps keep your costs down and keep you safe.

 

You’ll need PA for:*

 

  • 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 6 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.