Durable medical equipment and insurance coverage
Durable medical equipment explained
Durable medical equipment supports short-term recovery from surgery, injuries, or illness, as well as long-term management of chronic conditions or disability. The right DME makes it easier to do everyday tasks and can help you live a healthier, happier life.
Durable in DME means that the equipment can be used multiple times – sometimes for several years – before it needs to be replaced. Supplies meant to be used only once, like bandages after a surgery, aren't DME because they aren't reusable.
Common types of durable medical equipment
- CPAP machines
- Oxygen
- Nebulizers
- Wheelchairs
- Scooters
- Canes
- Patient lifts
- Hospital beds
- Prosthetics
- Orthotics
- Shower chairs
- Blood glucose meters
- Continuous glucose monitors
- Insulin pumps
How insurance works with durable medical equipment
- A prescription from your doctor. Just like with medication, a doctor needs to confirm that the equipment is necessary.
- An in-network DME supplier that can provide the needed items. This could be a medical supply store or pharmacy. Ask your insurance for a list of in-network suppliers.
- A list of insurance coverage requirements, like prior authorization. This is normally found in your explanation of benefits.
- Deductible: You may need to pay out of pocket before your insurance will begin covering the equipment.
- Coinsurance: Costs are often shared between insurance and you. For example, insurance may pay 80% while you pay the remaining 20%.
- Rentals: Some insurance companies require renting equipment for a period of time before approving its purchase.
Does insurance cover CPAP machines?
CPAP machines are prescribed for airway disorders like sleep apnea. Most insurance plans cover them with a doctor's prescription. Coverage typically includes the machine and the supplies needed to use correctly.
The mask, tubing, filters, and other parts can wear out with regular use, but insurance also typically covers replacements on a set schedule. Regular replacements are important because they help your CPAP work properly, keep the air clean, and ensure your treatment is safe and effective.
Does insurance cover wheelchairs?
Manual and power wheelchairs and scooters are typically covered by insurance, but likely need prior authorization. Your doctor will confirm what kind of equipment best fits your needs.
Coverage normally also includes basic accessories like cushions for pressure relief, armrests and footrests, safety features, and batteries or chargers for power chairs and scooters.
Financial support for equipment
Some DME manufacturers have programs that help with the cost of equipment and supplies. Additionally, community health organizations may have lending programs that can help you get temporary access to equipment.
If cost is a concern, make sure to talk with your doctor or insurance company to learn about available resources to help you receive the equipment and care you need.
