As we age, we may require assistive equipment to help us do things that were previously simple, such as climbing stairs or standing up from a chair. The majority of older adults have never previously encountered this type of adaptive equipment, and navigating this new world of insurance and vendors can be overwhelming. That’s why we’ve assembled this handy guide of everything you need to know about Durable Medical Equipment (DME).
What is DME?
It is important first to understand what “Durable Medical Equipment” (DME) is. According to Wikipedia, DME is “any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses”, such as wheelchairs, canes, walkers, and ventilators.
Unfortunately, equipment must also fit all of the following usage criteria:
- provide a therapeutic benefit to a patient in need due to certain medical conditions and/or illnesses
- be prescribed by a licensed provider
- not serve primarily as a comfort or convenience item
- not have significant non-medical uses
So, while a wheelchair is considered DME for one individual, it may not be considered as such for another.
Who Pays for DME?
Unfortunately, Medicare does not pay for all DME equipment.
Coverage by Medicaid varies state by state, and each state offers multiple Medicaid programs. Medicaid’s policy for seniors and who reside at home usually cover the cost of certain DME, given it is medically necessary and enables the individual to remain living at home rather than in a nursing home (payingforseniorcare.com).
If Medicaid will cover the necessary equipment, it often does so through a Medicaid Home and Community Based Services (HCBS) Waiver. These waivers “provide support and services to individuals who need a level of care equivalent to that provided in a nursing home to assist them in living independently”, such as home modifications (payingforseniorcare.com). Unfortunately, these waivers are not Medicaid entitlements, meaning enrollment in these programs is limited.
For veterans whose disabilities are related to service, VA health care will generally provide financial assistance with a large majority of adaptive equipment and home medical devices. HISA Grants are also available for disabled veterans whose disabilities are not military-related.
Some states have financial assistance programs for elderly or disabled individuals whose income exceeds Medicaid maximums – some of these programs include home modifications, though these programs vary state-to-state.
For those who are ineligible for financial assistance, tax deductions for medical expenses may be the only source of funding.
What Other Options Are There?
While DME Providers offer products that are typically covered by Medicare and/or Medicaid and usually work with insurance to handle payment, many equipment providers exist to fill the gap for equipment that is typically not covered by insurance, or for individuals who do not meet the qualifications for DME use.
While out-of-pocket costs for medical equipment may deter some shoppers, it is important to consider the alternative costs of moving into a new home, moving to an eldercare facility, or medical and emotional costs associated with a fall.