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Medicare and Durable Medical Equipment

Medicare and Durable Medical Equipment

A reality of growing older is that we will need the help of people more and more, and eventually the support of what’s known in the medical world as Durable Medical Equipment. These aid our ability to move, maintain good hygiene — even breathe. DME refers to all doctor-prescribed, in-home medical devices which have to meet certain criteria, including durability, medical necessity, and design for home use. The most familiar types of DME are walkers, wheelchairs, safety products for the bath, and nebulizers. Not considered DME are non-durable, disposable items such as needles, gloves, and bandages which can’t be prescribed by a doctor.

Is DME a category covered by Medicare? Yes, once you are enrolled in Part B (outpatient medical insurance). All that’s needed is for your doctor to approve the equipment as medically required and provide a prescription for it. During a nursing home visit, you won’t be covered since these are not considered “home” environments. But a long-term facility does qualify and will be covered. Once you’ve met your Part B annual deductible, Part B covers 80% of standard DME items such as crutches, wheelchairs, walkers, canes, and CPAP machines, and you are responsible for the 20% remainder. If your doctor can’t direct you to a DME supplier, Medicare.gov offers a tool, which will use your zip code to provide a list of pharmacies or stores carrying the item you need. Of course, the cost of the equipment will be more affordable if you are renting rather than buying it. The other cost variable is whether the DME supplier takes payment from Medicare for the approved amount. As far as vision coverage, Medicare will cover one pair of cataract glasses, contact lenses, or intraocular lenses following cataract surgery. Again, your part is 20% of the Medicare-approved cost after your Part B deductible is met. medigapcoverage.com powered by pollen recommends getting a Medicare Supplement policy to cover the 20% gap not paid by Medicare. Call one of our specialists at 1-833-245-0614 to learn which Medigap plan is best for your DME needs.

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FAQs

Durable Medical Equipment is one of the benefits of Medicare Part B. Once you’ve enrolled in Part B, you’ll be able to get any medically-required equipment you need. Just make sure you get a prescription from your doctor first.

Part B covers 80% of standard DME items such as crutches, wheelchairs, walkers, canes, and CPAP machines, and you are responsible for the 20% remainder.

  • Best overall Medicare supplement for new enrollees: Plan G.
  • Best overall Medicare supplement before 2020: Plan F.
  • Best low cost Medicare supplement: Plan K.
  • Best alternative to Plan G Medicare supplement: Plan N.

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Medicare Supplement policies are private health insurance designed to cover gaps in Original Medicare. They are also known as Medigap plans. These take care of costs such as copays, coinsurance, and deductibles which can become expensive if you need regular care from a doctor or hospital. If you need medical care while traveling outside the U.S., you can buy Medigap policies to help cover those costs. As a supplement to Original Medicare, you’re required to have Part A and Part B before you canget a Medigap policy. This way, Medicare is responsible for the Medicare-approved costs of the covered care, and the remainder is covered by your Medigap plan.

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Optimal coverage comes with higher costs, making Plan F the most expensive Medigap plan. Plan F is known as “first-dollar coverage” and it takes care of everything provided during a doctor or hospital visit. Your only responsibility is for dental, vision, medications, and equipment, such as hearing aids.

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The Federal government ended the Plan F option for new enrollees last year to keep the healthcare system from being overused by patients who had their deductibles covered. The next best coverage after Plan F is Plan G.

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Medigap Plan G offers every advantage of Plan F except for the deductible, which you have to cover. Because it isn’t as comprehensive as Plan F, Plan G is more affordable.

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For people who don’t go to the doctor often, Plan K is worth considering. It is the most affordable because it provides just 50% of Medicare Part B coinsurance, the Part A deductible, blood, skilled nursing, and Part A hospice costs. For comparison, Plan G and others offer full coverage of these expenses, and more.

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It’s hard to argue against plans which cut your traditional Medicare costs. For most people, having the extra coverage these supplemental plans provide is common sense, unless they want the specific features of a Medicare Advantage plan.

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Most people would benefit from not having to pay out-of-pocket to stay healthy. Medicare supplement insurance or a Medicare Advantage plan offer vital savings now, but are indispensable should a catastrophic health issue occur.

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Of the 10 Medicare-approved Medigap plans, Plan G and Plan N are the most popular. Plan F is no longer available to new Medicare enrollees as of 2020, but it is still popular among people who bought this plan prior to 2020.

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  • Plan F$128–$342
  • Plan F (high deductible)$22–$88
  • Plan G$106–$325
  • Plan G (high deductible)$29–$58

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Before getting a Medicare supplement plan, you need to be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). People with Medicare Advantage Plans who want to go back to Original Medicare can buy a Medigap policy prior to switching.

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The security of having lower or no out-of-pocket healthcare costs can offset the premiums you’ll have to pay for whichever Medigap plan you choose, which vary depending on the benefits offered.

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The national average cost for Medicare Supplement Plan F is $1,824 annually, which is $152/month; Medigap Plan G will cost you around $143 per month.

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Since Plan F was discontinued for new enrollees as of 2020, Plan G offers the most coverage for people 65 and older. It has a lower premium than Plan F and duplicates its benefits, except for the Part B deductible.

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It depends on your specific needs, but for most people a Medigap plan is very useful in supplementing the coverage of Medicare Part A and Part B. A Medicare Advantage plan is an affordable way to get healthcare coverage not offered by Original Medicare.

Historically, Plan F has been the most popular because it covers all the out-of-pocket costs Medicare does’t pay for. This includes the 15% extra charge billed by providers who do not take Medicare as full payment.

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Since January 1, 2006, no Medigap policy came with prescription drug coverage. You have two options to get covered, enrolling in either a Medicare Prescription Drug Plan (Part D) or a Medicare Advantage plan.

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