Know your Medicare Benefits
Your equipment and supplies may be covered
You probably expect that Medicare Part B will provide coverage for a walker, crutches or hospital bed if your doctor prescribes it. However, there is a long list of other specialty items designed to help maintain and improve the quality of your life that are considered Durable Medical Equipment (DME) and covered by Medicare Part B.
For example, do you have problems sleeping? Medicare Part B provides coverage for CPAP machines and equipment. Once you receive an initial diagnosis of sleep apnea you may be eligible to receive Continuous Positive Airway Pressure (CPAP) therapy for a three-month trial period. If your doctor determines that the sleep apnea therapy is helping, you and the equipment you need may continue to be covered under Medicare for a longer period.
A number of specialty items required after mastectomy surgery are also covered as Durable Medical Equipment, including:
· Multiple bras each year
· One silicone breast form every other year
· Compression garments and lymphedema sleeves
· Recovery care items and more.
The costs of managing diabetes can quickly add up if you don’t have Medicare Part B to help cover some costs. Even if you do not use insulin, your self-testing supplies, including blood sugar monitors, test strips, lancet devices and lancets are covered as DME. If your diabetes is causing foot problems, ask your doctor whether you qualify for therapeutic shoes, also covered as DME when prescribed by your doctor.
Your costs in Original Medicare
Medicare Part B will only cover medically necessary Durable Medical Equipment prescribed by your doctor. Medicare will cover your DME only if your doctor and DME suppliers are enrolled in Medicare. If suppliers are participating suppliers, they must accept assignment. In Ohio we have a law that states your doctor MUST accept what Medicare reimburses. They cannot balance bill you for the difference.
If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment and there’s no limit on the amount they can charge you. Always double check the supplier’s status to make sure they are participating.
Talk to your doctor if you are not sure whether the medical equipment you are using is considered DME by Medicare. You can also check with your Advantage Plan provider or visit www.Medicare.gov for more information.
For all your questions on insurance, including life, health, dental, vision and Medicare Advantage plans, please contact me at 440-255-5700. I look forward to helping you.
Laura Mutsko is a licensed insurance agent offering a complete line of health and life insurance products, including Individual, Group and Family Health, Medicare Advantage Plans, Medicare Supplement Plans, Medicare Part D Prescription Coverage, Vision, Dental and Life Insurance. Mutsko Insurance Services, LLC is located at 6966 Spinach Drive in Mentor, Ohio.