Does Medicare Pay for DME in a Nursing Home?

It’s essential to understand there are multiple Medicare parts to your insurance coverage. Each part covers specific items and medical services. This article will focus on Medicare Part A and Part B coverage for durable medical equipment (DME). 

Regarding the question, “Does Medicare Pay for DME in a Nursing Home?” Part A and Part B can provide DME, but there are certain conditions. This article will provide details on understanding how Medicare coverage includes DME. 

Medicare Part A and Part B 

There are two Medicare parts to your insurance coverage, Part A and Part B. There may be other parts available, but Part A and B are the only ones this article will review regarding DME. 

Medicare Part A will typically cover any costs regarding hospital and skilled nursing facilities. In comparison, Medicare Part B will typically cover any preventive services, medical equipment and supplies, tests, and doctor visits. 

Does Medicare Part A Pay for DME in a Nursing Home?

Yes, Medicare Part A insurance will cover skilled nursing facilities (SNF) and inpatient hospital stays, hospice care, and some home health care. The SNF will cover any DME equipment needed for patients for up to 100 days. 

An SNF is a facility with skilled nursing care staff, rehabilitative services, and other related health services. 

Does Medicare Part B Pay for DME in a Nursing Home?

No, Medicare Part B only covers DME for your home. Nursing homes and hospital stays don’t qualify as your “home.” There are two exceptions to this coverage. 

Exception #1

A long-term care facility can be considered your home as long as it doesn’t provide primarily skilled care or rehabilitation. 

Exception #2

If the SNF is still needed after 100 days, Medicare Part B might provide coverage for certain medical and health care services. You will have to check specifically with Medicare regarding your needs.

What Does Part B Cover?

Part B covers the DME items when a doctor or health care provider prescribes it to the patient. The insurance also covers certain doctor’s services, outpatient care, medical supplies, and preventive services.

DME Equipment Covered by Medicare Part B

DME includes medical equipment that helps you with your daily activities. If you’re not sure if a piece of equipment is considered DME, ask these four questions about the product.

  • Is the product durable and can be used repeatedly?
  • Does the product serve a medical purpose?
  • Will the product last for 3+ years?
  • Can this product be used in your home?

DME Examples

Some durable medical equipment will include:

  • CPAP devices
  • Crutches 
  • Hospital beds
  • Portable oxygen equipment 
  • Walkers
  • Wheelchairs
  • And more 

DMEPOS Equipment Covered 

Thanks to the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) category, Medicare Part B will also include:

  • Prosthetic devices that replace an internal organ 
  • Artificial legs, arms, etc.
  • Orthotics like neck braces, rigid or semi-rigid arms, legs, etc.
  • Some medical supplies 

Medicare Pays for DME in a Nursing Home!

Depending on your specific situation, Medicare can pay for DME in a skilled nursing facility. You have to meet certain conditions to ensure coverage. If you have any questions, it’s best to reach out to the Centers for Medicare and Medicaid Services (CMS) for answers. 

Who is Medbill?

Medbill is a full-service, 100% U.S.-based, DME billing company. The Medbill team helps DME providers become audit ready and assists them with document review, claims submission, and “behind-the-scenes” activities. Contact us today to learn how Medbill can help you. 

References:

Medicare Coverage of DME & Other Devices Government Booklet