Medicare and Durable Medical Equipment
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Medicare Explained
Medicare is a type of insurance that is provided for seniors over the age of sixty five or those who suffer from some forms of disability, which includes acute liver failure. It is federally funded by the United States Government and has been available for over thirty years.
Medicare is designed to offer affordable health care and covers things like doctors visits and hospital stays. Beginning very recently, Medicare also has started to cover prescription drug costs as well.
While typically, Medicare is operated directly by the federal government, those eligible for Medicare can opt to use a plan that is operated by private insurance companies. These plans are called Medicare Advantage Plans and are still funded by the government, but private insurance companies actually administer them.
Medicare Advantage Plans, or MA plans, have to cover the same things that Medicare covers, but are given some flexibility over how they cover it. This means, you might find a company that offers a discounted rate for prescriptions and doctors visits, but has more expensive rates for extended hospital stays. Recent legislation has changed the way MA Plans are funded, so it is important to compare the costs of the plans with that of traditional Medicare and determine which one will best fit your individual needs.
An Introduction to Durable Medical Equipment
Not only does Medicare cover hospital stays, but it also covers doctors visits and other things that you would expect typical medical insurance to cover. Medicare also covers the cost of durable medical equipment, which refers to home medical equipment, such as hospital beds, but also includes items such as prostheses and eye glasses.
Traditional Medicare was divided into only two parts, with Part A Benefits and Part B Benefits. Since its creation, there are now two additional types of benefits, specifically prescription medicine and Medicare Advantage Plans, however durable medical equipment falls under Part B Benefits.While there are a number of items covered by Medicare, not all types of medical equipment is covered and sometimes the insured must meet special requirements in order to receive reimbursement. Some of the items not covered include stair lifts and elevators, which are classified as home modifications. However, for most items Medicare will reimburse 80% of the cost of the medical equipment and will also often pay to have the item maintained. For most of the types of durable medical equipment that is covered by Medicare, all that is required is for the doctor to prescribe the item as part of a treatment to a medical condition. However, some items also require a Certificate of Medical Necessity. A Certificate of Medical Necessity is simply a prescription that is much more detailed and answers a specific set of questions. There are also sometimes special requirements put on the use of the piece of home medical equipment. For example, in order for a mobility scooter to be covered, the insured must require it for use around the home, and not simply when away from the house. Medicare Lift Chairs also have a good number of special requirements, including that the insured is not able to stand from any chair in their home.
Choosing the Right Plan
If you use traditional Medicare, then you can often receive reimbursement for your home medical equipment. Those who opt for a Medicare Advantage Plan, on the other hand, must be sure to read over the details of the plan. This is because the private insurance company is given a great deal of independence regarding how they cover each part of Medicare. So, it is possible for a Medicare Advantage Plan to offer a lower rate on doctor visits, while charging much more for home medical equipment.
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