Medical devices and durable medical equipment (DME) are covered under Medicare Medical Insurance (Part B) for beneficiaries in traditional Medicare (which is Medicare Hospital Insurance (Part A) and Part B). A medical professional such as a doctor, nurse, nurse practitioner, physician assistant or clinical nurse specialist must prescribe them for use in the home. In addition to a private home, an assisted living facility can also be considered a residence.
Medicare pays 80 percent of the cost of these items and beneficiaries pay a 20 percent co-payment. In order to qualify for payment, the equipment must be ordered through an approved Medicare supplier.
Suppliers can be found through the Medicare website. Help is available via phone by calling 1-800-MEDICARE (633-4227). The TTY number is 1-877-486-2048.
Once a supplier has been located, it is important for beneficiaries to obtain the supplier number when ordering equipment. This information is critical for filing a claim for reimbursement. If a supplier is not an approved member of the Medicare program, Medicare will not pay anything for the equipment or device.
Beneficiaries should be very careful when placing an order and use only companies officially listed as “participating suppliers.”
Medicare explains what can go wrong:
“Suppliers who agree to accept assignment on all claims for durable medical equipment and other devices are called “participating suppliers.” If a durable medical equipment supplier doesn’t accept assignment, there is no limit to what they can charge you. In addition, you may have to pay the entire bill (Medicare’s share as well as your coinsurance and any deductible) at the time you get the durable medical equipment. The supplier will send the bill to Medicare for you, but you will have to wait for Medicare to reimburse you later for its share of the charge. Important Note: Before you get durable medical equipment, ask if the supplier is enrolled in Medicare. If the supplier is not enrolled in Medicare, Medicare won’t pay your claim at all. Then, ask if the supplier is a participating supplier in the Medicare Program. A participating supplier must accept assignment. A supplier that is enrolled in Medicare, but isn’t “participating” has the option whether to accept assignment. You will have to ask if the supplier will accept assignment for your claim.”
