As the elderly population has
growth progressively due to the influence of the babyboom generation, there has
been an increased need for seniors to purchase home or durable medical
equipment. 15% of approximately $100 billion ($15 billion) would paid for
directly out-of-pocket of consumers. Therefore, it is important to maximize the
assistance the seniors receive from the insurance coverage or minimize their
out-of-pocket spending on durable medical equipment.
There are about 55.5 million
elderly people covered by Medicare in US. Medicare pays for much of their
health care, but not all of it. Medicare covers most acute medical conditions –
conditions from which a patient usually recovers. But, Medicare does not cover
most care given at home, in assisted living facilities or in nursing homes, for
people with chronic disabilities and lengthy illnesses. Through my internship with
Bridge Disability Ministries, there are a lot of customers whose relatives are
placed in assisted living facilities, in nursing homes, or at home with chronic
disabilities and lengthy illnesses. The customers have come to us because they
could not afford the renting fee of the durable medical equipment, such as
airbeds, commodes, or wheelchair at the healthcare organizations. Our customers
often say that the fee for nursing homes is about $7500/month covered by their
pocket. This is a big money and will immediately affect to their normal living.
When come to the question that “Do Medicare's Benefits Include durable medical
equipment?” the short answer is yes. However, it be depended on the type of
coverage, and there is a list that Medicare will cover.
Medicare Part A is hospital
insurance. It has strict requirements for medical equipment which require individuals
must be Homebound. The individuals cannot leave their home without assistance
and they must require skilled nursing care. Medicare Part A will pay for 80% of
the allowable amount for any specific item, and leaving the 20% responsible and
any amount over the allowable limit for the individuals.2 However,
guest what, the allowable limit for the individuals would run out quickly to
cover medical spending needed. In addition, there are many people who even not
able to afford the 20% price of expensive equipment, such as power wheelchair,
or full electric hospital bed. As a result, they are looking for supports from
non-profit organizations where they could come and have the durable medical
equipment needed with affordable prices. Bridge Disability Ministries medical
equipment center is one kind of the place where people may find a full function
power wheelchair for themselves with a price just around 15% of the new one in
the market. The money paid would be under the donation form. In addition, the
employees in the center would help them to adjust the power wheelchair without
charging fee. So, with this supports, the people visiting Bridge Disability
Ministries would pay only 15% value of the equipment, with a money that could
put in their tax return, and free technical services.
Part B is for outpatient services. Part
B pays for durable medical equipment which must be for use in the home or
personal care residence such as assisted living but not in a nursing home. Durable
medical equipment must be medically necessary and purchased from a
Medicare-approved supplier. As same as Medicare Part A, the Part B pays for 80%
of the allowable purchase price and the individual is responsible for the
remaining 20% and any amount over the allowable limit.2
Part C also called Medicare
Advantage, is a combination of Part A and Part B and is sold by private
companies instead of provided by the government. Therefore, if one has Medicare
Part C, their plan will pay at least 80% of the allowable limit.2
Beside
the type of Medicare coverage, a durable medical equipment is covered or not
also depend on if it listed in Medicare coverage. There are a lot of medical
equipment needed that will not be covered by the list, such as, bath or shower
seat, transfer tub bench, or transfer wheelchair. At Bridge Disability
Ministries equipment center, transfer wheelchair is a hot subject with a lot of
people come to ask for and, that could in and out the inventory every day. The
transfer wheelchair is lighter with smaller wheels comparing to the manual
wheelchair. It supports for transferring patient from place to place, and very
handling to put it into a car. A transfer wheelchair is cheaper than a manual wheelchair
but it is not covered by Medicare. However, the function of a transfer wheelchair
is so important for elderly people, especially women, who do not able to lift
40lb of a wheelchair. Without a transfer wheelchair, a lot of people could not
able to help their partner or relative visit doctor appointments, or coming to
a community center.
In conclusion, a durable medical equipment is covered or not by Medicare
depending on both the type of coverage, and be in the list of Medicare coverage.
However, whatever the type of coverage that an individual is covered, he or she
must be responsible for the 20% of the equipment price from the supplier and
any amount over the allowable limit. There a lot of people do not able to
afford that amount of money and looking for a non-profit charity organization
like Bridge Disability Ministries where they could find durable medical
equipment needed with affordable prices.
References:
1. 1. How to Pay for Home and Durable Medical
Equipment: a Comprehensive Guide. Payingforseniorcare.com. https://www.payingforseniorcare.com/durable-medical-equipment/how-to-pay-home.html.
Accessed July 19, 2016.
2. 2. Do Medicare's Benefits Include Home / Durable
Medical Equipment? Payingforsenior.com. https://www.payingforseniorcare.com/durable-medical-equipment/medicare.html.
Accessed July 20, 2016.
