| It is logical to assume that a large proportion of our | | | | bathroom |
| country's older residents will require home medical | | | | - Hearing aids |
| equipment and supplies at some point in their lives. But | | | | - Examination gloves |
| the need for home medical equipment and supplies is | | | | - Some catheters |
| not limited to the elderly. Injuries, illness and disabilities | | | | - Incontinence supplies such as briefs and underpads |
| can strike at any age. | | | | Be sure to research the factors that affect how much |
| Perhaps you or a loved one will require home medical | | | | Medicare coverage you will receive. Make sure all |
| equipment in the near future. If so, it is important to | | | | paperwork is completed correctly and that you buy |
| understand what you need to do in order for your | | | | your equipment through an approved supplier that |
| insurance to help to cover the cost. | | | | accepts assignment. |
| Medicare | | | | Medicaid |
| Medicare is our country's health insurance program for | | | | Medicaid is a state-run insurance program and may |
| people age 65 or older. In certain cases, individuals | | | | differ from state to state. In most cases, you will need |
| younger than age 65 may be covered by Medicare if | | | | prior approval from Medicaid before ordering your |
| they have qualifying disabilities or diseases as | | | | medical equipment and supplies. Your doctor must |
| designated by Medicare. | | | | explain in writing: |
| Medicare covers numerous types of medical | | | | - Your diagnosis and prognosis |
| equipment and supplies where there is a documented | | | | - How the equipment/supplies will aid recovery and/or |
| need for them. Often this documentation begins with a | | | | daily life functions |
| prescription by the attending physician followed by a | | | | - Expected consequences of no equipment/supplies or |
| Certificate of Medical Necessity. | | | | not using the recommended equipment/supplies. |
| People in the hospital, home health care, or a nursing | | | | - If substituting less expensive equipment is |
| home are covered by Medicare Part A. Otherwise, | | | | unacceptable, explain why. |
| medical equipment and supplies may be covered by | | | | - Length of time the items are needed |
| Medicare Part B. | | | | - You have been or will be instructed how to use the |
| Medical supplies and equipment that are covered by | | | | equipment properly and that you are able to do so. |
| Medicare include: | | | | Physician-prescribed home medical equipment covered |
| - Some catheters | | | | by Medicaid may include: |
| - Ostomy supplies, ostomy bags, and irrigation and | | | | - Hospital beds |
| flushing equipment, and supplies | | | | - Wheelchairs |
| - Supplies required for feeding tubs (such as catheters, | | | | - Speech devices, computer screen readers for blind |
| filters, and nutrient solutions) | | | | or visually impaired users, vocal amplifiers and similar |
| - Supplies for tracheotomy care | | | | communication augmentation |
| - Dressing required for treatment of a wound caused | | | | - Bath or shower chairs |
| by a surgical procedure or after debridement | | | | - Dialysis equipment |
| (removing non-living tissue of a wound) | | | | - Oxygen equipment, tanks and supplies |
| - Diabetic supplies, glucose monitors and Diabetic | | | | - C-pap and bi-pap equipment and supplies |
| Shoes | | | | - Walkers, crutches, and canes |
| - Respiratory supplies including home oxygen | | | | - Nebulizers and medication delivery devices |
| equipment & equipment for sleep apnea | | | | - Commodes, and elevated toilet sets |
| - Vacuum devices for impotence treatment | | | | - Traction equipment. |
| - Manual wheelchairs, electric wheelchairs, and | | | | Medicaid typically will not cover items like air |
| motorized scooters | | | | conditioners or exercise equipment where there is no |
| - Augmentative communication devices | | | | illness or injury involved, even if they are prescribed by |
| - Orthotics and prosthetics, when these devices are | | | | a doctor. |
| considered medically necessary or when they replace | | | | Private and commercial health insurance |
| or support a body part | | | | Private and commercial health insurance, including |
| Other supplies and equipment may be covered if they | | | | employer-sponsored group plans and individual plans |
| can be shown to be medically necessary and your | | | | vary widely. It is extremely important for you to |
| doctor has documented it in your medical records. | | | | diligently research eligibility, requirements and coverage |
| Not all medical equipment and supplies are covered by | | | | criteria for your specific private health insurance. Be |
| Medicare. Some are considered "personal | | | | sure to check for specific forms and procedures for |
| convenience" items. Examples of items which are not | | | | compliance with the preapproval process and the |
| covered include: | | | | medical documentation. It's also important to confirm |
| - Raised toilet seat | | | | that your insurance carrier is contracted with the |
| - Shower/commode wheelchair | | | | specific Durable Medical Equipment supplier from which |
| - Grab bars and other safety equipment for the | | | | you plan to purchase the equipment or supplies. |