Dear Marci,
 
I have been having difficulty moving around my home, and my doctor wants to order some kind of durable medical equipment (DME) for me. Does Medicare cover DME?
 
-Patricia (Kailua, HI)
 
Dear Patricia,
 
Durable medical equipment (DME) is equipment that helps you complete your daily activities. It includes a variety of items, such as walkers, wheelchairs, and oxygen tanks. Medicare usually covers DME if the equipment:

• Is durable, meaning it is able to withstand repeated use
• Serves a medical purpose
• Is appropriate for use in the home, although you can also use it outside the home
• And, is likely to last for three years or more

To be covered by Part B, DME must be prescribed by your primary care provider (PCP). If you are a skilled nursing facility (SNF) or hospital inpatient, DME is covered by Part A.

Whether you have Original Medicare or a Medicare Advantage Plan, the types of Medicare-covered equipment are the same. Examples of DME include:

• Wheelchairs
• Walkers
• Hospital beds
• Power scooters
• Portable oxygen equipment

Under the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) category, Medicare Part B also covers:

• Prosthetic devices that replace all or part of an internal bodily organ
• Prosthetics, like artificial legs, arms, and eyes
• Orthotics, like rigid or semi-rigid leg, arm, back, and neck braces
• Certain medical supplies 

Medicare Part B also covers certain prescription medications and supplies that you use with your DME, even if they are disposable or can only be used once. For example, Medicare Part B covers medications used with nebulizers. Medicare also covers lancets and test strips used with diabetes self-testing equipment.
 
Note that there are also certain kinds of equipment and supplies that Medicare does not cover, such as equipment for use mainly outside the home, and most equipment that is thrown out after one use or not used with equipment.
 
To find out if Medicare covers the equipment or supplies you need, or to find a DME supplier in your area, call 1-800-MEDICARE or visit www.medicare.gov. You can also learn about Medicare coverage of DME by contacting your State Health Insurance Assistance Program (SHIP).
 
-Marci

https://lifeafter50expo.com/2021/12/4263/

Dear Marci, I need to begin outpatient treatment for substance use disorder, but I am not sure where to start.  Does Medicare cover treatment for substance use disorder, and how can I access these services? -Linda (Hoover, AL) Dear Linda, Yes, Medicare covers alcoholism and substance use disorder treatment if:Your provider states that the services are medically necessaryYou receive services from a Medicare-approved provider or facilityAnd, your provider sets up your plan of careExamples of these services include but are not limited to:Patient education regarding diagnosis and treatmentPsychotherapyPost-hospitalization follow-upOpioid treatment program (OTP) servicesPrescription drugs administered during a hospital stay or injected at a doctor’s officeOutpatient prescription drugs covered by Part DStructured Assessment and Brief Intervention (SBIRT) services provided in a doctor’s office or outpatient hospital. SBIRT is covered by Medicare when individual shows signs of substance use disorder or dependency. SBIRT treatment involves:Screening: Assessment to determine the severity of substance use and identify the appropriate level of treatment.Brief intervention: Engagement to provide advice, increase awareness, and motivate individual to make behavioral changes.Referral to treatment: If individual is identified as having additional treatment needs, provides them with more treatment and access to specialist care.If you are unsure where to start with your treatment, first talk to your doctor. You can speak with your doctor about substance use disorder treatments that may be best for you, and they may be able to recommend providers to you. Remember that in order for Medicare to cover your substance use disorder treatment, your provider must set up your plan of care and state that the services are medically necessary. Once you know the kinds of services you need, you can call 1-800-MEDICARE if you have Original Medicare to find behavioral health care providers and facilities in your area. You can also use the Provider Compare tool on www.medicare.gov to find mental health providers who accept Medicare payment. If you have a Medicare Advantage Plan, you can contact your plan to find mental health care providers who are in your plan’s network and to learn about any costs or restrictions associated with getting care. Finally, you can also contact the Substance Abuse and Mental Health Services Administration (SAMHSA) at 800-662-4357 for additional help finding behavioral health care providers. SAMHSA may also be able to direct you to local resources. -Marci

Dear Marci, 

I would like to begin individual therapy sessions with a psychologist and focus more on my mental health. Will Medicare cover therapy appointments with a psychologist? 

-Jesus (Santa Rosa, CA) 

Dear Jesus, 

I am so happy that you are taking steps to care for your mental health. Yes, Medicare does cover outpatient mental health care services, like individual therapy sessions. There are some important considerations to take when choosing your provider, if you would like to ensure your care is covered and to save money. Let’s discuss Medicare coverage and outpatient mental health care services more. 

Medicare Part B covers outpatient mental health care, including the following services: 

• Individual and group therapy 

• Substance use disorder treatment 
• Tests to make sure you are getting the right care 
• Occupational therapy 
• Activity therapies, such as art, dance, or music therapy 
• Training and education (such as training on how to inject a needed medication or education about your condition) 

• Family counseling to help with your treatment 
• Laboratory tests 
• Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you 
• An annual depression screening (speak to your primary care provider for more information) 

Original Medicare covers the outpatient mental health services listed above at 80% of the Medicare-approved amount. This means that as long as you receive services from a participating provider, you will pay a 20% coinsurance after you meet your Part B deductible. If you are enrolled in a Medicare Advantage Plan, contact your plan for cost and coverage information. Your plan’s deductibles and copayments/coinsurance may differ. 

Medicare covers mental health care you receive through an outpatient hospital program, at a doctor’s or therapist’s office, or at a clinic. You may receive services from the following types of providers: 

• General practitioners 
• Nurse practitioners 
• Physicians’ assistants 
• Psychiatrists 

• Clinical psychologists 
• Clinical social workers 
• Clinical nurse specialists 

If you see a non-medical doctor (such as a clinical psychologist or clinical social worker), make sure that your provider is Medicare-certified and takes assignment. Medicare will only pay for the services of non-medical doctors if they take assignment. 

It is also important to note that psychiatrists are more likely than any other type of provider to opt out of Medicare. Be sure to ask any provider if they take your Medicare insurance before you begin receiving services. Remember, if you see an opt-out provider, they must have you sign a private contract. The contract states that your doctor does not take Medicare and you must pay the full cost of the service yourself. Medicare will not reimburse you if you see an opt-out provider. If your provider does not have you sign a contract, you are not responsible for the cost of care. 

If you have Original Medicare and need help finding a participating provider, you can use Medicare’s Physician Compare tool online or call 1-800-MEDICARE. If you have a Medicare Advantage Plan, call your plan directly for a list of mental health care providers in your plan’s network. For additional assistance accessing behavioral health care providers and other local resources, call the Substance Abuse and Mental Health Services Administration (SAMHSA) at 800-662-4357.   

-Marci