Durable Medical Equipment

Other important things to consider concerning suppliers:

You should make sure that your supplier accepts assignment. If a supplier accepts assignment, this means the supplier accepts Medicare’s terms and will always accept the Medicare-approved amount as full payment. The Medicare-approved amount is the maximum amount that Medicare has set for rental or purchase of an item, and no supplier accepting assignment can charge more than this amount. Suppliers that accept assignment are called “participating suppliers,” and in order to receive your fullest Medicare benefits it will normally be to your advantage to rent or purchase equipment from a participating supplier.

CMS cautions: “If a durable medical equipment supplier doesn’t accept assignment, there is no limit to what they can charge you. In addition, you may have to pay the entire bill (Medicare’s share as well as your coinsurance and any deductible) at the time you get the durable medical equipment. The supplier will send the bill to Medicare for you, but you will have to wait for Medicare to reimburse you later for its share of the charge.”

There are Medicare suppliers that are not participating suppliers but accept or reject assignment on a case-by-case basis. If there is no participating supplier in your area and you need help finding a local supplier that accepts assignment, CMS advises visiting medicare.gov and selecting “Find Suppliers of Medical Equipment in Your Area.” You can also get information by calling 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.

Does Medicare usually cover rental of equipment, or purchase?

Most often, Medicare covers rental costs. According to CMS, “Medicare only purchases inexpensive or routinely purchased items, such as canes; power wheelchairs; and in rare cases, items that must be made specifically for you.”

With regard to specific items, any Medicare-enrolled supplier should be able to tell you whether Medicare covers rental or purchase.

When Medicare covers rental of a DME item, Medicare coverage is normally in the form of monthly payments. When items are rented, the supplier pays for repairs or replacement parts, and the supplier will come to pick up items in need of repair or replacement.

Although Medicare often covers purchase of inexpensive medically-necessary items, these items are sometimes rented. CMS cautions: “Total rental payments for inexpensive or routinely purchased items are limited to the fee Medicare sets to purchase the item.” Before renting such an item, therefore, you should try to determine whether it is really more cost-effective and practical to rent the item than to purchase it.

For some items, Medicare will cover rental as long as the item is medically-necessary. There is no limit, for example, to how long Medicare will cover a ventilator as long as it remains a medical necessity for use in the home.

For other items, rental payments from Medicare will end after a specified time. Most oxygen equipment rental, for example, will typically be covered by Medicare for up to 36 months at a time. After that, the supplier must continue providing medically-necessary oxygen equipment and supplies at no charge for another two years. According to CMS, “At the end of the 5-year period, your supplier’s obligation to continue furnishing your oxygen and oxygen equipment ends, and you may elect to obtain replacement equipment from any supplier. A new 36-month payment period and 5-year supplier obligation period start once the old 5-year period ends and the new oxygen and oxygen equipment you require is furnished.”

For items that are purchased, Medicare may also cover repairs or replacement parts. For a purchased item that is stolen or damaged beyond repair, Medicare may cover replacement of the item.

The CMS list of covered DME items is not necessarily complete. Items such as CPAP (continuous positive airway pressure) and BPAP or BiPAP (bilevel positive airway pressure) devices are medically necessary

for many Americans with serious respiratory problems including sleep apnea, and Medicare normally covers temporary rental of such equipment. If you have a medical need for any DME item you do not see on a list of Medicare-covered items, you should call 1-800-MEDICARE for clarification.

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