Medicare & Insurance
What Type of Items Will Medicare Cover?
Many home medical products are covered by Medicare. What Medicare doesn’t cover, secondary insurance often will. Home modifications usually are not covered by Medicare or insurance, but may be through non-profits, waiver programs, reverse mortgages, special home improvement loans, foundations and churches.
Remember to weigh the cost of alternative care versus the cost of making your home environment more accessible through modification.
- The average annual cost of skilled care at a nursing home is $78,000 for a private room, or $69,000 for a semi-private room.
- Assisted living costs an average of $36,000 annually.
- The average rate for an in-home health aide is $19 per hour.
- Adult day services average about $16,000 if care is provided five days a week.
If you need help with financing, your home medical equipment provider can help.
|
Epuipment/Item |
Covered* |
Normal Coverage Requirements |
Bathroom Safety Equipment |
No |
|
Canes, Walkers |
Yes |
Mobility limitations, please call us for specifics. |
Cervical Traction |
Yes |
Patient has impairment and home traction has proven effective. |
Commode |
Rarely |
Only if patient is confined to an area with no toilet facility. |
Compression Stockings |
Sometimes |
Covered when used to treat open venous ulcers. Otherwise, not covered. |
CPAP |
Yes |
Covered with diagnosis of obstructive sleep apnea and specific test documentation of apnea events. |
Diabetic Supplies |
Yes |
Covers glucose monitor, lancets, test strips, control solution and replacement batteries. Does not cover insulin injections or pills (except as may be covered under Part D.) |
Emergency Communicators |
No |
|
Enteral or Parenteral |
Yes |
Enteral covered for patients unable to swallow, delivered via tube. Not covered for those taken orally. |
Grab Bars |
No |
Bathroom safety equipment is not covered. |
Van Lifts and Ramps |
No |
|
Hospital Beds |
Yes |
Covered if one of these conditions is met: (1) medical condition requires body positioning not feasible in ordinary bed, (2) patient requires head of bed elevated more than 30 degrees most of the time due to a medical condition, or (3) patient requires traction equipment. |
Incontinence/ Adult Diapers |
No |
|
Lift Chairs |
Rarely |
Only covered if patient is unable to stand up from any chair, but once standing he or she can walk. Medicare pays only for the lift mechanism, not the chair portion. |
Manual Wheelchairs |
Yes |
Usually covered. We can help assess patient needs. |
Mobility Equipment |
|
Covers the least level of equipment needed to help patient be mobile within his or her home and accomplish daily activities. Canes and crutches are the lowest level, followed by walkers, followed by manual wheelchairs, followed by scooters, followed by power wheelchairs. Requires face-to-face evaluation by physician and home evaluation. |
Orthopedic Shoes |
Sometimes |
Paid when needed to attach shoe to leg brace. |
Ostomy Supplies |
Yes |
Covered for patients with colostomy, ileostomy and urostomy. |
Oxygen |
Yes |
Covered for patients with significant hypoxemia when blood gas or oxygen levels indicate a need. Equipment rental paid for a limited period of time. |
Patient Lifts |
Sometimes |
Covered if transfer between bed and chair requires assistance of more than one person and patient would otherwise be confined to bed. Electric lift mechanisms are not covered. |
Power Wheelchairs |
Often |
Several specific criteria. We can help assess patient needs. |
Raised Toilet Seats |
No |
Bathroom safety equipment is rarely if ever covered. |
Scooters |
Sometimes |
We can help determine coverage. |
Stair Lifts |
No |
|
Support Surfaces |
Usually |
Many coverage criteria, all based on medical necessity. |
TENS Units |
Yes |
For certain chronic pain lasting more than three months. |
Therapeutic Shoes |
Yes |
Shoes, inserts and modification covered for diabetic patients with specific foot conditions. |
Urological Supplies |
Yes |
Covered for permanent urinary incontinence. |
Wound Care |
Yes |
Covers primary and secondary dressings. Must have surgery/debridement. |
*For items that are covered by Medicare, Medicare pays 80 percent, patient is responsible for 20 percent. For private insurance, percentage of coverage varies by plan.