Welcome back! This blog provides financial resources and information for people living with cancer. In this post, I want to focus on medical equipment, durable and nondurable.
Durable Medical Equipment (DME)
DME includes medical equipment used multiple times in your home. Blood sugar monitors, wheelchairs, electric scooters, walkers, and oxygen as well as other safety items are considered DME and are typically covered under your health insurance (often not at 100%). You may need a prescription for DME in order for the insurance company pay for them. Before purchasing or renting DME, call the member services phone number on the back of your insurance card and check what your plan covers. Also ask if you need to order from a specific supplier that will directly bill your insurance company. If possible, you want to avoid paying the entire amount out of pocket, and then having to submit paperwork to your insurance company for reimbursement.
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Medicare Part B (Medical Insurance) typically covers medically necessary DME if your doctor prescribes it for use in your home. Medicare, however, does not cover all types of durable medical equipment. Hearing aids are not covered, and many home safety items, such as lifts, grab bars for bathroom safety and ramps are not covered. However, this can vary depending on your plan. Your out-of-pocket expense also depends on your Medicare plan.
DME suppliers need to be enrolled in Medicare for Medicare to pay. You will need to ask the pharmacy or store where you plan to purchase equipment if they participate in Medicare. If they do not participate, Medicare will not pay, and there is no limit to what the supplier can charge you for equipment, so it’s best to choose a pharmacy or store that does participate in Medicare.
Medicaid also pays for DME. Included items vary from state to state. For information on your state go to: Contact Your State With Questions | Medicaid
Commercial Health Insurance plans vary on which DME items they will pay for and how much they will pay. Contact member services for your plan to get details.
Non-Durable Equipment/ Medical Specialty Equipment (MSE)
MSE includes items that are typically disposable, not intended for multiple use, and serve a medical purpose. Items include ostomy supplies, incontinence products (including catheters), batteries for insulin pumps, cervical collars, back braces, etc. A prescription is required to have the insurance company pay for them.
Medicare typically does not pay for MSE, however there are a few exceptions: diabetes management supplies, ostomy supplies, and feeding tube supplies. There will be a limit on the number of supplies that your Medicare plan will pay for each month. If this number is not sufficient for your care, ask your health care provider to submit a request/appeal to your insurance company for additional supplies. Like ordering DME, if you want Medicare to pay, MSE orders must be placed through a supplier that is enrolled in Medicare.
Medicaid pays for more MSE than Medicare does. Again, this varies by state, so contact your state Medicaid office for details. Also, your pharmacist may be able to assist. It has been my experience to never pay out of pocket for supplies while anticipating reimbursement from Medicaid. It’s best to work through Medicaid up front.
Commercial Health Insurance plans may cover MSE, but typically only limited items and at a portion of the cost. Check with member services before you purchase supplies.
Where can you obtain DME or MSE if you do not have health insurance?
First, ask your health care provider for resources. If your cancer treatment team includes a physical therapist, social worker, or nurse navigator, ask them for assistance. They will know of discount programs and charity organizations in your area.
Ask your local pharmacist. They often have information on resources for equipment and supplies.
Contact the manufacturer of the product. Often manufacturers will offer discounts or free products to uninsured patients and may offer additional resources. I have found this to be especially helpful with ostomy products as well as tube feedings.
You may also want to check with local charitable organizations in your area. They may have donated items available for free, or at a reduced cost. If they do not, ask their representative what agency in your area would be able to help.
St. Vincent DePaul: SVDP USA | Providing Assistance to Those in Need for Over 150 Years > Home
A word of caution: Check all used items found at charities to ensure safety. Check that the brakes work on wheelchairs. Walkers have non-slip rubber tips or wheels. Take electric scooters for a test ride to ensure seat stability, steering and brake function as well as all parts are included.
The Patient Advocate Foundation’s (PAF) National Financial Resource Directory can help you locate some of the programs mentioned above. Search under “Manufacturer’s Patient Programs” and “Other Medication Assistance” to produce a list of possible resources
I hope this information is helpful. If you would like to continue this conversation, please click on the Subscribe button at the top of the Blog page. I would love to hear your comments as well as resources that have worked for you. Please share this information with your family and friends.
Keeping you in my prayers,
Jackie
For introductory information and to understand the mission of this blog, please see Introduction – Living with cancer take my hand
