Medicare recently released an update that announced several cuts, changing the way the insurance will cover certain products and services. Durable medical equipment (DME) coverage is one of the many things that has changed.
Durable medical equipment, including home safety aids, are covered by Medicare Part B that is necessary and prescribed by your doctor to use in your home. In order to be considered DME, it must meet these criteria:
- Can withstand repeated use
- Used for medical reasons
- Not useful to someone who isn't sick or injured
- Used at home
- Expected to last at least three years
In 2015, retail spending for DME, reached $48.5 billion, including items like eyeglasses, hearing aids, mobility aids, wheelchairs, and more.
So far, it seems that all people with Medicare Part B are covered. However, if you're enrolled in the original Medicare program, there are gaps in coverage. These gaps include:
Routine services: Routine checkups for things like foot care, vision, hearing, and dental care are not covered. However, Medicare does cover medically necessary care, such as jaw surgery after a serious injury or goof problems caused by diabetes or cancer. Medicare will also not cover any medical services outside of the United States and its territories except under very rare circumstances.
Home safety aids: Items like grab bars in the bathroom, bathroom benches, commodes, stair lifts, bathtub lifts, or medical alert systems are not covered. Medicare will cover certain items if deemed medically reasonable by a doctor.
Long-term care: Medicare will not cover long-term care in nursing homes or assisted living facilities. Medicare will cover medical needs, but not custodial care including things like getting dressed, going to the bathroom, or feeding. It will, however, cover short-term care in skilled nursing facilities when someone qualifies.
Medically unnecessary services: Medicare will not cover services it does not consider medically necessary, such as cosmetic surgery, alternative medicines, or fitness programs.
Note: Medicare Advantage plans, such as HMOs or PPOs, must cover all the same Part B services that the original Medicare program does. But they may also offer extra benefits that cover some of the gaps listed above. Some plans, for example, provide coverage for routine hearing, vision and/or dental care, fitness programs and gym memberships, and emergency care abroad. Check with your plan.
What you can do
To make sure you are covered for certain services and home safety aids, make sure you:
Pay attention to terms: When it comes to Medicare billing, it's important to pay attention to the vocabulary used so you know exactly what you're being billed for. Sometimes, what you think something means could have a completely different meaning to the medical staff.
Ask about your status: While you're at the hospital, ask about your status. Most hospitals are required to tell you if you're being admitted into inpatient and if you're going to need follow-up care.
Keep track of current class action: There is unfortunately no way to appeal inpatient and outpatient status currently with Medicare. So, you should pay attention to class action lawsuits like the one in Connecticut that could pave the way for patients to file an appeal.
Your medical coverage is important, and you have the right to know what is going on with it. For more information, contact your insurance provider so you know exactly how you're covered.
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