Durable Medical Equipment

As people age, there may be a time when one will need a walker, cane, or wheelchair. Most people tend to go to the store and purchase one when they recognize the need for balance support.

Most insurance plans do cover physical and occupational therapy to help address balance changes. Therapy services are delivered under a physician’s order through an outpatient clinic if one is community mobile. If one is unable to leave the community and meet the homebound criteria, they can receive services in the home through a home health agency.

Medicare will cover some type of mobility device such as a front wheeled walker or a wheelchair. The coverage is 80% by insurance and the remaining 20% is the patient’s portion. Usually one device is covered every 5 years. Wheelchairs are rent to own for 13 months with the cost share spread over that time. A medical profession such as a PT or OT can help fit one for a wheelchair with a physician order.

Hospital beds can be covered by Medicare also under certain circumstances also. The usual bed covered is a semi-electric bed that has the head of bed and foot being controlled with buttons, however, the height of the bed must be adjusted by a crank.

Full electric beds that have all 3 adjustments need special justification to have it covered. You can upgrade a hospital bed by paying a difference for the added feature.

Hospital beds also come in different heights in addition to the standard height. This is an important feature when caring for someone who may crawl out of bed unassisted and fall. One can request for an extra low type of frame to help reduce fall risk.

It is always best to check that you are getting properly assessed and trained for the piece of durable medical equipment (DME) before accepting it. Also, be sure to keep all paperwork for the DME should it have problems or need to be repaired or changed out.

DME such as commodes or tub and shower chairs are not covered by Medicare as it is considered hygiene equipment. There are special criteria needed to get coverage and consulting with your insurance can help guide you.