What is Durable Medical Equipment?
Whether you’re trying to comfortably age in place or manage an illness, keeping up with all of the medical jargon can be difficult. To assist you, we’ll look at a common term you’ll hear as you become older: durable medical equipment (DME). DME may appear simple because you already know what each phrase implies. Still, it’s a term used by Medicaid, Medicare, and other insurance providers.
DME is medical equipment that is designed to last for more than one user and is frequently designed to survive for months or even years. Crutches and oxygen tanks are examples of durable medical equipment. Many health insurance policies include DME supplies, allowing you to avoid paying for it out of yourself. Durable medical equipment is one of the many items that an injured or unwell person may require from the healthcare system to cope with their injury or disease. This is in addition to medications, supplements, procedures, and other treatments. Access to durable medical equipment can often mean the difference between life and death, or at the very least between severe suffering and relative comfort. Durable medical equipment is frequently included in health care plans due to its importance.
- Orthoses of the Shelf
- Orthoses Prefabricated
- Neurostimulators
- Neuromuscular Electrical Stimulation
What is covered under Durable Medical Equipment (DME)?
Medical devices and supplies that may be reused, such as a hospital bed at your home or a prosthetic limb, are examples of durable medical equipment. Single-use medical equipment, such as bandages or incontinence pads, is the polar opposite of DME.
It’s crucial to know what qualifies as DME and what doesn’t, as this impacts insurance coverage. The majority of government and private health insurance plans will cover all or a portion of durable medical equipment costs.
To qualify as DME, an item must meet the following criteria:
- It must primarily serve a medical function
- It must be prescribed or ordered by a medical provider
- It must be reusable.
- It must be utilized in the patient’s house
- It must be useful to the patients who have an accident or handicap
- It must have a projected lifetime of at least three years
The following are common examples of durable medical equipment used outside of a hospital:
- Personal care aids such as bath chairs, dressing aids, and commodes
- Mobility aids including walkers, canes, crutches, wheelchairs, and scooters
- Oxygen concentrators, monitors, ventilators, and related supplies
- Bed equipment such as hospital beds, pressure mattresses, and lift beds
Are Hearing Aids Long-Lasting Medical Devices?
Hearing aids appear to meet the criteria for durable medical equipment when you read the criteria. After all, you wear them daily, and they last for more than three years. However, they aren’t considered DME, unfortunately.
Hearing loss affects over 25% of individuals aged 65 to 75 and 50% of those aged 75 and up, however hearing aids are still not categorized as durable medical equipment and are not covered by Medicare or other private insurance companies. Instead, they are categorized as either elective or Class I medical devices. By definition, Class I medical devices aren’t medically necessary. Because DME only contains products that are medically required, hearing aids aren’t included under DME.
Adaptive Medical Equipment vs. Durable Medical Equipment
As mentioned in the list, durable medical equipment comprises reusable medical devices and supplies. Adaptive equipment is a type of equipment that assists seniors and people with short or long-term disabilities. However, it does not have to be medically necessary. Devices and supplies that help with mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) fall under the category of adapted equipment (IADLs). Items that make the dressing, bathing, toileting, eating, communication, entertainment, and movement easier, safer, or more accessible fall under this category.
Does Medicaid cover Durable Medical Equipment?
Medicaid systems differ by state, which means that what Medicaid covers differs as well. We recommend contacting your state’s Medicaid office or visiting their website for the most up-to-date information.
Medical equipment that is medically essential, cost-effective, and fulfills the state’s definition of durable medical equipment will generally be covered by Medicaid. That definition varies, although it’s frequently the same as the one used by Medicare. Many Medicaid programs will cover the entire cost of any home medical equipment you require.