Senior Life Matters
The Means To Obtain Durable Medical EquipmentBy Janell Sluga
As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms, prices and products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
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Question: I am having trouble walking within my home and when outside. Can I get a walker or cane that Medicare will cover, and how do I go about getting it?
Answer: The type of equipment you are asking about is classified under the heading of Durable Medical Equipment. This equipment is provided to Medicare beneficiaries with a doctor's order. The list of DME includes, but is not limited to, walkers, wheelchairs, hospital beds, sleep apnea machines, oxygen and many others.
To qualify for the classification of DME the item must be reusable. Items like walkers are purchased outright under Medicare Part A or B, depending on the situation. The Medicare deductible applies, then Medicare pays 80 percent and you - or your secondary insurance - would pay 20 percent. If you have a Medicare Advantage plan, look at your enrollment packet information to see what your cost share would be for these items. It is usually a flat co-pay such as $20 per item or monthly rental.
For the larger items, like hospital beds and wheelchairs, Medicare usually rents these items for approximately 13 months. Oxygen supplies are 36-month rentals. After this rental period, the equipment is yours to keep and Medicare pays for any maintenance necessary during the rental period and up to 6 months after renting. If an item costs more than $150, it is usually rented. If it is under $150, it is usually purchased outright.
In order to get this equipment paid for by Medicare, you must have a doctor's order or prescription. You then take it to a Medicare Participating Durable Medical supplier. We have many in our area. Once there, they will help you choose a product that is right for you, fit it to your person and, if necessary, deliver it to your home.
If you purchase this equipment without renting it first, Medicare will not reimburse you for this expense.
Many of these items can be replaced after a reasonable amount of time. Each item has its own duration of usability. This means if you get a walker this month and Medicare or your Medicare Advantage plan helps to pay for it, you may qualify for a replacement in usually five years. If your item needs to be replaced prior to that period, you and your physician may file a request to have it replaced soon, with the reasoning behind your request.
There are some items that cannot be purchased at the same time - for instance, a wheelchair and a walker with a seat. Therefore, you must evaluate which would be more useful for you at this time and get that item through Medicare. If your condition changes, and you then require the other item at a later date, you can try to get it at that time. If it is a short period of time between the requests, your physician may need to submit additional paperwork justifying your request.
One item that is very popular lately is a motorized wheelchair. These come in all different styles and makes - some three-wheeled, some four. Some look like a standard wheelchair, some are almost minicars. When they first were marketed, they were relatively easy to get through Medicare and other insurance carriers. Now the regulations and paperwork are much more complicated. I know I used to see infomercials all the time stating ''Guaranteed approval or it is free.'' I don't see these so much anymore. I always hesitate when I see something advertised like that. I have found that a promise like this is too good to be true many times.
In looking for the DME, be sure to evaluate what you think you want before requesting paperwork from your doctor. You may want to visit a DME showroom to see all the different types of equipment available. The traditional silver walker with no wheels has been upgraded with many very useful features. Look around and decide what item suits your situation best, then talk with your physician about getting the necessary paperwork - prescription or doctor's order - to get the piece of equipment.
Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing. She has worked in Chautauqua County with Seniors for more than 16 years. She is HIICAP - Health Insurance Information, Counseling and Assistance Program - counselor trained by Office For the Aging.
She does not sell insurance, or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.
You may submit questions to be answered in later columns to Janell Sluga, at Senior Life Matters 737 Falconer St. Jamestown, NY 14701 or by e-mail at janells@lutheran-jamestown.org. Please remember that not all questions can be answered in this format, but as many as can be, will be.
