Helping Seniors Live Healthier Lives

Is Durable Medical Equipment Covered By Health Insurance?

Durable Medical Equipment is equipment that is generally used in the home to help a person attain higher functionality and improve their quality of life. Unfortunately, not all medical equipment used in the home is covered by health insurance.

How to Know What's Covered and What's Not Covered

Some types of durable medical equipment are not covered by health insurance because it is deemed an item of convenience or comfort. It is always good to check with your health insurance plan to find out what they cover when it comes to medical equipment. You can also find out more about what types of durable medical equipment is covered by reading your evidence of coverage.

It is important to note the health insurance industry is changing rapidly and what not might have been covered previously could very well be covered currently. For instance, breast pumps were at one time considered an item of convenience and not covered. Since the enactment of the Affordable Care Act, however, health insurance companies now cover them 100 percent.

Some examples of types of equipment that are normally covered by health insurance include:

  • C-PAP machines and supplies
  • Wheelchairs
  • Crutches
  • Home oxygen and supplies
  • Orthotics and artificial limbs

Some examples of types of equipment not normally covered by health insurance include:

  • Shower chairs
  • Safety railing systems
  • Exercise equipment
  • Massage devices
  • Power beds

How Durable Medical Equipment Gets Covered

Some kinds of durable medical equipment is only covered as a rental and not a purchase. For example if you need crutches, chances are you will not need them for long-term use so health insurance companies cover it as a rental. Other types of medical equipment require prior authorization. This is to ensure the equipment is in fact, medically necessary. It is the responsibility of your doctor or medical equipment supplier to submit medical records to obtain prior authorization. Most insurance companies require authorization for any type of rental or if the equipment costs over a certain dollar amount.

Even though your health insurance company says it will cover the medical equipment, it does not necessarily mean they will cover the full cost. More often than not, you will have to meet your deductible first. After your deductible is met, you may still have to pay your coinsurance. Once your deductible and coinsurance are met, the required authorizations are in place, and it is something your health insurance company normally covers, they will pay the remaining amount. If your insurance company denies your claim for durable medical equipment, you do have the right to appeal.

Visit Lincoln Mobility if you need medical equipment.