by: Kim Cantrell
CFILC’s Director of Programs
Do you know what your health insurance policy covers when it comes to durable medical equipment (DME)?
But first, what exactly is durable medical equipment? According to Medicare.gov, durable medical equipment must:
- have a lifespan of at least 3 years;
- be used for a medical reason and in your home; and
- cannot usually be useful to someone who isn’t sick or injured.
Based on the definition above, DME includes wheelchairs, walkers, scooters, hospital beds, commode chairs, blood sugar monitors, crutches, gait trainers, nebulizers, oxygen equipment and accessories and more.
In 2011 I wrote a blog post commenting on the state of DME coverage and the restrictions placed on many private insurance policies (again, not including Medi-Cal, Medicare or other government-funded plans).
Since then, the Affordable Care Act (ACA) was implemented. Unfortunately, the DME situation hasn’t improved, and in many cases coverage continues to deteriorate.
Although the ACA mandates insurance plans cover specific DME like breast pumps for new mothers, it doesn’t include coverage requirements for common DME like wheelchairs, walkers, shower chairs, and CPAP machines.
Insurance companies living with new ACA mandates are cutting costs where they can. Since generalized DME coverage is not mandated, health insurance plans are offering less DME coverage, coverage caps, or no coverage at all. All of these scenarios are alarming for anyone who relies on DME. And honestly, even if you don’t rely on DME right now, you might in the future, and that is why you should care about DME coverage too.
Over the next couple of months I’m going to share stories of people who are directly affected by the reduction or elimination of their DME coverage. These people pay for private, commercial insurance here in California. And they are not getting their DME needs met or they are forced to pay out of pocket, resulting in a financial hardship.