Friday, April 12, 2013

Medical Equipment for Home Use

The proliferation of medical equipment that you can order and obtain online is significant and sometimes confusing. The way most people figure it, if it is available online and I can get it without a doctor having to approve it, then my insurance company will pay the bill if I submit a claim.

Stop right there … you may be in for a surprise or two. Let us talk about what most people use in terms of medical insurance at the point in their lives when they routinely need medical equipment of some type to treat health problems, namely Medicare and Medicaid. In general, these programs cover the cost of the equipment itself but that is not the whole story. A lot of this equipment also requires the place where you live to be modified to be able to use the equipment effectively. Medicare and Medicaid DO NOT cover home modifications in any way. If you are a veteran, the VA is a little more progressive and has grant programs where they will give you the money to at least pay for some of the cost of home modification.


Pay attention to the rules when you are dealing with Medicare or you just might end up in a significant amount of unintended debt. Let us talk about the Part B stuff now. First, any medical equipment you need MUST BE certified as needed by a licensed doctor. That usually means you must have a prescription from the doctor with his signature on it. Second, the medical equipment must be portable. It cannot be permanently installed or affixed to the house in any permanent manner. The words you are looking for in the Medicare book of knowledge is “durable medical equipment.”

Once you have sorted that out in your mind and have a level of comfort with the process, you can either rent or buy the eligible items. The typical stuff we are a talking about is hospital style beds, wheelchairs, scooters, oxygen equipment, blood sugar meters, blood dialysis machines and a host of other things needed for the physically challenged and medically informed patient. Note the common characteristics of these items … they are all free to move and are not attached to anything but you when you use it. If you need a safety railing in your shower, DO NOT think that Medicare will provide it. They will not. Why not? Because, it is a piece of equipment that is permanently mounted. Just because you think you need it to be safe means nothing to Medicare.

There is also a Part C to Medicare called Medicare Advantage. This plan potentially provides extra coverage for equipment not covered under Part B plus the out of pocket expenses are lower as well. As you know, this is the State’s extension of the Federal Medicare program. As a result, you can expect the same rules to apply in general. The one thing to check out with the State program is to see if they are running any special programs that deal with permanent home modifications. It will be a special rule that the state is providing the money for, so the Medicare book of knowledge doesn’t apply. Look at State’s rules and follow the guidelines and application procedure. Be approved BEFORE you contract with a home builder to make the modifications.

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