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What is Durable Medical Equipment (DME) and How Do I Qualify?

breast pump

Healthcare professionals often prescribe medical supplies such as oxygen equipment, PAP machines, and diabetic supplies for home use. These items are known as Durable Medical Equipment (DME) and are intended to help you manage your health from the comfort of home. DME can also be called Home Medical Equipment (HME). Insurance companies generally offer coverage for DME, and healthcare supply and equipment companies can deliver DME directly to your home.

What is Durable Medical Equipment?

Durable Medical Equipment (DME) is medical equipment or supplies a healthcare provider prescribes to you for home use. Health insurance plans, including Medicare and Medicaid, offer coverage for commonly prescribed DME. The exact DME coverage depends on your insurance. Medicaid coverage varies by state, but most Medicaid plans cover a wide range of items. Equipment often includes:

  • Diabetic supplies
  • Briefs, diapers, catheters, and other incontinence products
  • Breast pumps and other breastfeeding supplies
  • CPAP machines and supplies
  • Other equipment designed for home use
  • Other supplies designed to help you manage your health at home

Medicare coverage for DME is more limited than Medicaid coverage. As a rule, Medicare only covers equipment and supplies it considers medically necessary. This means Medicare doesn’t cover items such as incontinence or breastfeeding supplies. DME items covered by Medicare includes:

  • Test strips and diabetic supplies
  • CPAP machines and supplies
  • Medically necessary supplies designed to help manage your health at home

Commonly prescribed DME/HME

DME includes equipment and supplies you might need to recover from a hospital stay, manage a chronic health condition, or care for a disability in your home. Commonly prescribed DME includes items such as:

  • Blood sugar monitors, test strips, glucose monitors, and other diabetic supplies
  • CPAP machines and supplies
  • Walkers, canes, and other walking aids
  • Wheelchairs, scooters, and other mobility devices
  • Oxygen equipment
  • Nebulizers
  • Patient lifts
  • Orthotics
  • Hospital beds
  • Briefs, diapers, catheters, and other incontinence products
  • Breast pumps and other breastfeeding supplies

What is a DME/HME provider?

A DME or HME provider is a healthcare company that helps you secure medical equipment for your home through your insurance. DME providers contract with insurance companies to get coverage for medical supplies. Providers can then handle communications between your doctor, insurance company, and you.

The process starts when your doctor prescribes medical equipment. Once you have a prescription, you can choose a DME/HME provider that accepts your insurance plan. The DME supplier will check your eligibility and collect all the correct paperwork on your behalf. The provider will then deliver medical equipment directly to your home.

What to look for in a DME/HME provider

There are several important qualifications to look for when you select an HME/DME provider. High-quality DME providers will have:

  • Easy qualification — DME providers should make it easy to see which medical equipment your insurance covers by simply providing them with your information.
  • Curated shopping — A DME provider should allow you to filter products and only see the equipment that is covered by your insurance plan.
  • Dedicated customer service — The DME/HME provider you select should manage the process of getting medical equipment from your doctor’s prescription to your front door. Customer service reps should be on hand to take care of the paperwork, provide you with education about your DME/HME, and follow up after delivery to ensure everything is going well. You can check reviews online to see if your DME has happy customers.
  • Fast, free, and discreet shipping — DME/HME should arrive to you quickly and in discrete boxing.

Why is DME/HME important?

DME/HME can help you manage your health and improve your quality of life. DME can be ordered from home and delivered straight to you. It’s also a great way to get the necessary supplies without barriers such as childcare coverage or transportation arrangements.

How much does DME cost?

The cost of your DME will depend on your insurance coverage. Private insurance companies aren’t required to offer coverage for DME, but most plans provide

 some coverage. If you’re enrolled in a federal insurance plan such as Medicare and Medicaid, coverage will differ depending on the exact policy you have.

You might still be responsible for a copayment or coinsurance amount even when insurance provides DME coverage. For example, Medicare typically covers 80 percent of the cost of medically necessary DME. The remaining 20 percent is charged to the patient.

How do I qualify?

Your healthcare provider can help you get the DME/HME you need. They can offer recommendations for quality DME providers that might be a good fit for you. After you secure a prescription, you can contact a DME provider. Many providers have qualification forms on their websites that allow you to check your insurance coverage. If you qualify for DME coverage, the DME provider will handle your next steps. They’ll work with your insurance company and medical provider to complete all the paperwork and deliver DME to you.

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Information provided on the Aeroflow Health blog is not intended as a substitute to medical advice or care. Aeroflow Health recommends consulting a doctor if you are experiencing medical issues or concerns.

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