Although there are a number of medical conditions that can limit mobility in older adults, there are plenty of ways for them to stay active both in their homes and on the go. One of the easiest solutions is to obtain specialized homecare medical equipment. Medical device manufacturers have developed a wide range of products that seniors can use to maintain their mobility and independence.
Identifying what type of healthcare medical equipment an aging loved one needs and knowing how to obtain it, can be a challenging experience. Fortunately, the team at Homethrive is here to help you make the best choice for your family’s situation.
Deciding What Type of Homecare Medical Equipment You Need to Buy
When assessing what sort of home medical equipment to purchase for your aging loved one, it’s important to understand the specific categories that are available to consumers. Setting aside any significant questions of what kind of assistance your loved one needs (Do they have difficulty walking? Are they prone to bruising?), identifying what type of equipment to buy is important for insurance purposes and meeting guidelines for home care.
Durable Medical Equipment
When most people talk about buying medical equipment for the home, they’re typically talking about what healthcare professionals (and, more importantly, insurance providers) refer to as durable medical equipment (DME). This equipment helps aging adults (or anyone with a medical condition) to function in the home on a regular basis and is both reusable and long-lasting.
The Social Security Administration’s Program Operations Manual System (POMS) stipulates that DME is equipment that can “withstand repeated use...is primarily and customarily used to serve a medical purpose...and generally is not useful to a person in the absence of an illness or injury.”
In most cases, DME is a mechanical device of some kind, although it doesn’t have to be electronic or motorized to qualify. Wheelchairs, walkers, handrails, and commodes all count as DME, in addition to more complicated equipment like adjustable hospital beds, scooters, vital signs monitors, ventilators, and nebulizers.
Also known as assistive devices, this category is actually very close to DME and is often used interchangeably. The Assistive Technology Act of 2004 defines assistive technology (AT) devices as “any item, piece of equipment, or product system...that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.”
Put simply, all DME qualifies as assistive technology, but not all assistive technology meets the definition of DME. This distinction is important when it comes to insurance reimbursement, as many providers do not cover AT devices that are not considered DME. Devices like speech readers, reachers, and telephone relay services may qualify as AT because they help aging adults to function independently in their homes, but they are not DME because they could have some other use.
Home Medical Supplies
Not all homecare medical equipment is designed for repeated use. Home medical supplies are any devices or equipment that are intended for either single-use or multiple uses by a single individual. Although they serve a specific medical purpose, they don’t usually require a prescription to obtain. In most cases, they are disposable items, but even if they can be used more than once, they generally cannot be shared for hygienic reasons. Some examples of home medical supplies include adult diapers, diabetic test strips, respiratory tubing, and other urological supplies.
What Type of Medical Equipment is Covered by Insurance?
The first question that most people ask about homecare medical equipment is whether or not Medicare will cover the costs for any DME their aging loved one requires. Unfortunately, the answer is rather complicated and depends upon the type of insurance involved.
While Medicare Part B does cover “medically necessary” DME, it will only do so if that equipment is prescribed by a doctor who is enrolled in Medicare. Their practice or hospital must also work with a DME supplier that is enrolled and participating in Medicare. This last part is important because if the supplier is enrolled in Medicare but not a participant, there is no limit on how much they can charge patients for DME.
If the supplier accepts the assignment (which they do not have to if they are “enrolled” but not “participating” in Medicare), patients pay 20% of the Medicare-approved amount for the DME. Depending upon the equipment in question, patients may be able to decide whether they want to rent or buy the equipment.
All DME must meet the following requirements for Medicare reimbursement:
- Durable (can withstand repeated use).
- Used for a medical reason.
- Not usually useful to someone who isn’t sick or injured.
- Used in your home.
- Has an expected lifetime of at least 3 years.
Because Medicaid is administered at the state level, there is no single standard for how the program covers DME costs. Generally speaking, however, Medicaid covers a broader range of homecare medical equipment, but usually only pays for the most inexpensive options available. For aging adults with low incomes who want to remain in the home rather than in an assisted living facility, there are special Medicaid programs (such as HCBS or 1915 Waivers and “Money Follows the Person” [MFP] Programs) available in certain states that provide more flexibility when it comes to paying for equipment.
Most private insurers have lists of specific DME and medical supplies that are covered under their policies. To begin the process of obtaining the equipment, patients will need to start with a prescription from their doctor. Most healthcare practices and hospital groups work regularly with medical equipment suppliers that know how to bill insurance providers for reimbursement. If they do not have the equipment on hand, they can quickly put patients in contact with a number of qualified suppliers.
How to Budget for Home Healthcare Equipment
In some cases, DME is very easy to obtain at a low cost from wholesalers or major online retailers. Items like braces, canes, or even wheelchairs are relatively simple devices that don’t require special vendors or suppliers. It may be less expensive to simply purchase these items on the open market rather than working with a healthcare provider’s preferred vendors. When it comes to obtaining more complex devices, however, such as diagnostic or respiratory equipment, it may be preferable to follow the recommendations of medical professionals.
The decision to rent or buy equipment will generally be determined by how long it will be needed. If an aging adult requires a wheelchair while they recover from a fall, it might make sense to rent one until they complete their rehabilitation. Even then, however, it may be wise to take a long-term view. If a senior is at risk for mobility-related problems in the future, buying DME like a wheelchair instead of renting one could avoid future headaches.
Get the Advice You Need From Homethrive
Navigating the complex regulatory environment surrounding home medical equipment can be a confusing experience, especially when your aging loved one needs help right away. That’s why Homethrive’s Care Guides are available to provide guidance and advice when it comes to securing the equipment your family member needs to continue living a comfortable and independent life. To learn more about how our Care Guides can help you develop a comprehensive plan that works for you and your aging loved one, sign up today for a free trial. If you’re already a member, we can connect you to a number of fully-vetted DME providers who can meet your equipment needs.