Will Medicare Pay to Replace Durable Medical Equipment (DME)?
Medicare will generally pay to replace durable medical equipment that you rent or own at any time if it is lost, stolen, or damaged beyond repair in an accident or natural disaster. However, you must have proof of the damage or theft.
Replacement for durable medical equipment means substituting one item for an identical or nearly identical piece of equipment. Medicare will pay for you to switch from one manual wheelchair to another, but it will not pay for you to replace your manual wheelchair with a motorized scooter.
Medicare will only replace your durable medical equipment if you have had the item in your possession for its whole lifetime. So, if your durable medical equipment is “worn out” the lifetime of the item must be assessed. An item’s lifetime depends on the type of equipment but it is never less than five years from the date you began using the durable medical equipment. This five-year timeframe is different from the three-year minimum lifetime requirement that most medical equipment must meet to be considered DME by Medicare. The item must be so worn from day-to-day use that it can no longer be repaired.
It’s important to note that Medicare covers repairs for worn durable medical equipment if the DME has not reached the ends of its lifetime. Medicare will pay for repairs up to the cost of replacement.
To be eligible for a DME replacement, your primary care provider must write a new order or prescription explaining your medical needs. It is most cost-effective to use a Medicare-approved supplier who accepts assignment.
To find out if Medicare covers the equipment or supplies you need, or to find DME suppliers in your area – you can always visit medicare.gov, or contact Medicare Pathways to help guide you through how you can help ensure your coverage gaps are closed!