Global Courant
It is logical to assume that a large proportion of our country’s elderly residents will need medical equipment and supplies for the home at some point in their lives. But the need for home medical equipment and supplies is not limited to the elderly. Injuries, illness and disabilities can strike at any age.
Perhaps you or a loved one will need home medical equipment in the near future. If so, it’s important to understand what you need to do to make sure your insurance will cover the cost.
Medicare
Medicare is our nation’s health insurance program for people age 65 or older. In certain cases, individuals under age 65 may be covered by Medicare if they have qualifying disabilities or illnesses as designated by Medicare.
Medicare covers many types of medical equipment and supplies when there is a documented need for them. This documentation often starts with a prescription from the treating physician followed by a Declaration of Medical Necessity.
People in the hospital, home care, or nursing home are covered by Medicare Part A. Otherwise, medical equipment and supplies may be covered by Medicare Part B.
Medical supplies and equipment covered by Medicare include:
- Some catheters
- Ostomy supplies, ostomy pouches, irrigation and flushing equipment and supplies
- Nutrient tray supplies (such as catheters, filters, and nutrient solutions)
- Supplies for tracheotomy care
- Dressing required for the treatment of a wound caused by a surgical procedure or after debridement (removing non-living tissue from a wound)
- Diabetic supplies, glucose meters and diabetic shoes
- Breathing supplies, including home oxygen equipment and sleep apnea equipment
- Vacuum devices for impotence treatment
- Manual wheelchairs, electric wheelchairs and mobility scooters
- Supporting communication tools
- Orthoses and prostheses, when these devices are deemed medically necessary or when they replace or support a body part
Not all medical equipment and supplies are covered by Medicare. Some are considered “personal convenience” items. Examples of things that are not covered are:
- Raised toilet seat
- Shower/toilet wheelchair
- Grab bars and other bathroom safety features
- Hearing aids
- Exam gloves
- Some catheters
- Incontinence material such as briefs and pads
Be sure to research the factors that affect how much Medicare coverage you receive. Make sure all paperwork is completed correctly and that you are purchasing your equipment through an authorized supplier who will accept the job.
Medicaid
Medicaid is a state-administered insurance program and can vary from state to state. In most cases, you will need prior approval from Medicaid before ordering your medical equipment and supplies. Your doctor must explain in writing:
- Your diagnosis and prognosis
- How the equipment/supplies aid recovery and/or daily living functions
- Expected consequences of no equipment/supplies or failure to use recommended equipment/supplies.
- If substitution of cheaper equipment is unacceptable, explain why.
- The length of time the items are needed
- You have or will receive instructions on how to use the equipment correctly and that you are able to do so.
Doctor-prescribed home medical equipment covered by Medicaid may include:
- Hospital beds
- Wheelchairs
- Speech devices, computer screen readers for blind or visually impaired users, vocal amplifiers and similar communication enhancements
- Bath or shower chairs
- Dialysis equipment
- Oxygen equipment, tanks and supplies
- C-pap and bi-pap equipment and supplies
- Walkers, crutches and walking sticks
- Nebulizers and drug delivery devices
- Commodes and raised toilet sets
- Traction equipment.
Medicaid typically does not cover items such as air conditioners or exercise equipment that do not involve illness or injury, even if they are prescribed by a physician.
Private and business health insurance
Private and commercial health insurance plans, including employer-sponsored group plans and individual plans, vary widely. It is extremely important for you to diligently research eligibility, requirements, and coverage criteria for your particular private health insurance plan. Be sure to check for specific forms and procedures for compliance with the pre-approval process and medical documentation. It is also important to confirm that your insurance company has a contract with the specific durable medical equipment supplier from which you intend to purchase the equipment or supplies.
Get insurance to cover the cost of the house
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