Durable Medical Equipment (DME) is covered in the state of Colorado under your Medicare Part B plan. DME is equipment with a medical purpose, designed to be used repeatedly over time in your home. Some examples of DME include blood sugar testing supplies, canes, oxygen equipment or nebulizers.
Types of equipment not covered in Colorado:
There are some types of DME that Medicare doesn’t cover. Examples include:
- Equipment you need only outside your home. For example, if you are mobile in your home, Medicare won’t cover a motorized scooter to assist you in covering longer distances outside the home.
- Equipment that is designed to make things only more comfortable that isn’t medically necessary. Items, such as shower chairs, toilet seats or stairwell lifts, are not covered under Medicare. Disposable items are typically not covered under DME.
- Single-use items, such as gloves, facemasks or incontinence pads, are not covered. However, some disposable medical supplies are covered as part of home healthcare benefits.
- Your Colorado Medicare plan also does not cover modification made to your home. This includes wheelchair ramps or widening of doorways for access.
Must be medically necessary
For Medicare to cover DME, it must be medically necessary. It means your doctor must advise that it is medically necessary for your home.
Should you rent or purchase the DME?
In Colorado, Medicare will determine if you should rent or purchase the DME you need. The DME must be prescribed by a physician who accepts Medicare, and the supplier you chose must also accept Medicare assignments.
To get an accurate measure of your cost, speak to your Colorado-based provider. However, there are few considerations to determine your out-of-pocket cost for each piece of DME:
- Insurance other than Medicare you may have.
- The amount your doctor charges you.
- Where you get the DME.
Colorado’s Competitive Bidding Initiative
The Competitive Bidding Program for Colorado DME was created to help keep the costs of DME down. To be affected by the competitive bidding program you have to:
- Have Original Medicare.
- Live in a competitive bidding program area, like Denver or Colorado Springs.
- Have a medically necessary need to DME that is included in a competitive bidding program.
Special requirement for oxygen equipment and supplies in Colorado
Medicare coverage requirements for oxygen and related supplies are different than those for other types of DME. While you still must use the correct Colorado supplier, there are some things to take note of.
- Oxygen equipment is rented to you for a 5-year term. The equipment is never purchased for you.
- For the first 36 months, Medicare will pay the supplier a rental fee for the equipment, supplies and any maintenance necessary. During this initial 36 months, you are responsible for paying 20 percent of the fee.
- After the 36-month period, you are no longer responsible for rental fees. During this time, you can keep the equipment for 24 additional months. You also become responsible for a 20 percent coinsurance payment for maintenance of the equipment. Also, if you use tanks or oxygen cylinders, you continue to pay a 20 percent coinsurance fee per month for these items.
Coverage for DME in Colorado
Your DME falls under your Medicare Part B in the state of Colorado. There are types of DME that Medicare doesn’t cover and certain requirements you must meet, such as selecting the right provider. Note that there may be out of pocket expenses, such as coinsurance for certain types of equipment.