Medicare covers most DME items. Medicare considers all items to be either routinely purchased, capped rentals or supplies.

Routinely Purchased

Routinely purchased items are relatively inexpensive such as canes, walkers and glucometers. Upon payment by Medicare the patient owns the product. It should be noted that the 5 year rule applies to these items (see below for explanation of the 5 year rule). Glucometers are an exception as they are purchased every three years.

Capped rental items

Capped rental items are generally more expensive, and complex items such as beds, wheelchairs, nebulizers, and many others. Most of the products we deliver fall into this category.

The capped rental system is best understood as a rent-to-own program. Under the capped rental system Medicare will pay for an item for 13 months. At the end of the 13th month, the patient owns the equipment. They can keep it indefinitely, sell it, dispose of it, etc. If the patient needs it for less than 13 month it is returned to the supplier.

Oxygen is a capped rental item. However it has different a different set of rules. Please see the prescribing oxygen section for more information.

Supplies

Medicare pays for the purchase of supplies when used with medically necessary equipment. These include enteral formulas, glucose test strips, catheters and nebulizer medications. A three month supply is usually sent to the patient on a quarterly basis. It is helpful if the prescription is written with enough refills to facilitate this method of delivery.